Provider Demographics
NPI:1962554360
Name:GEHRIG, THEODORE
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:GEHRIG
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TED
Other - Middle Name:
Other - Last Name:GEHRIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:427 A ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1976
Mailing Address - Country:US
Mailing Address - Phone:916-645-3300
Mailing Address - Fax:916-645-3311
Practice Address - Street 1:427 A ST STE 400
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1976
Practice Address - Country:US
Practice Address - Phone:916-408-6946
Practice Address - Fax:916-645-3311
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT45296106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist