Provider Demographics
NPI:1487958856
Name:ALLEN, GAILA MARIE (MA/MFT)
Entity type:Individual
Prefix:MS
First Name:GAILA
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA/MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 DANA ST
Mailing Address - Street 2:#2B
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2878
Mailing Address - Country:US
Mailing Address - Phone:510-898-1800
Mailing Address - Fax:510-898-1801
Practice Address - Street 1:2550 DANA ST
Practice Address - Street 2:#2B
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2878
Practice Address - Country:US
Practice Address - Phone:510-898-1800
Practice Address - Fax:510-898-1801
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28242106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist