Provider Demographics
NPI:1487712097
Name:GERBER, MICHAEL HANFORD (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HANFORD
Last Name:GERBER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2178 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93410-0001
Mailing Address - Country:US
Mailing Address - Phone:805-547-1650
Mailing Address - Fax:805-547-1995
Practice Address - Street 1:2178 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:805-441-9250
Practice Address - Fax:805-781-1177
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18085103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist