SUSIE LILLIANA GAMBOA (NPI# 1740893353) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740893353 |
| Entity Type | Individual |
| Full Name | SUSIE LILLIANA GAMBOA |
| Credential | MS, AMFT |
| Practice Address |
340 Hwy 138 Crestline CA 92325 |
| Mailing Address |
Po Box 6300 Crestline CA 92325-6300 |
| Practice Telephone | 9093363330 |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2020-09-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | 119718 | CA | Behavioral Health & Social Service Providers |
| N | 171M00000X | Case Manager/Care Coordinator | 119718 | CA | Other Service Providers |
| Street Address |
340 HWY 138 |
| City | CRESTLINE |
| State | CA |
| Zip Code | 92325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245773217 | Rhonda Boss | Marriage & Family Therapist | 340 Hwy 138, Crestline, CA 92325-6300 | 2016-11-23 |
| 1497367312 | Hannah Littrell | Case Manager/Care Coordinator | 340 Hwy 138, Crestline, CA 92325 | 2020-08-21 |
| 1942812862 | Miranda Keri Velasquez | Case Manager/Care Coordinator | 340 Hwy 138, Crestline, CA 92325 | 2020-08-21 |
| 1689206989 | Leona Chen | Case Manager/Care Coordinator | 340 Hwy 138, Crestline, CA 92325 | 2020-02-05 |
| 1841837317 | Kelly Simione | Case Manager/Care Coordinator | 340 Hwy 138, Crestline, CA 92325 | 2019-12-04 |
| 1518514322 | Tyler J Glenn | Case Manager/Care Coordinator | 340 Hwy 138, Crestline, CA 92325 | 2019-08-26 |
| 1366098170 | Ivonne Andrea Omana | Student in an Organized Health Care Education/Training Program | 340 Hwy 138, Crestline, CA 92325 | 2019-08-16 |
| 1295390599 | Samuel Edward Baney | Marriage & Family Therapist | 340 Hwy 138, Crestline, CA 92325 | 2019-05-02 |
| 1861952343 | Alysha Taylor Kerr | Case Manager/Care Coordinator | 340 Hwy 138, Crestline, CA 92325 | 2019-03-21 |
| 1073090775 | Louise Melendez | Student in an Organized Health Care Education/Training Program | 340 Hwy 138, Crestline, CA 92325 | 2018-07-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639707672 | Yvonne Marie Luna | Massage Therapist | 25268 Ca-18, Crestline, CA 92325 | 2020-03-27 |
| 1427600451 | Joelle Jacobs | Marriage & Family Therapist | 340 Ca-138 Highway, Crestline, CA 92325 | 2019-07-10 |
| 1497215420 | Jeffrey Dean Whitney | Behavior Technician | 22792 Laurel Ln, Crestline, CA 92325 | 2019-03-25 |
| 1801352869 | Jayne M Schuljak | Student in an Organized Health Care Education/Training Program | 23406 Crestforest Dr, Crestline, CA 92325 | 2019-02-14 |
| 1841766953 | Daniel Scott Ferryman | Student in an Organized Health Care Education/Training Program | 23406 Crest Forest Dr., Crestline, CA 92325 | 2018-10-16 |
| 1215440607 | Lori Jean Butler | Case Manager/Care Coordinator | 340 State Highway 138, Crestline, CA 92325 | 2017-11-08 |
| 1164965133 | Monique Chatrisa | Counselor | 24174 Wabern Drive, Crestline, CA 92325 | 2016-11-23 |
| 1992256549 | Chelsea L Guest | Dentist | 23571 Lake Drive At Fern, Crestline, CA 92325 | 2016-10-19 |
| 1659724219 | Jean Sherman | Licensed Vocational Nurse | 23406 Crest Forest Dr, Crestline, CA 92325 | 2016-07-19 |
| 1619330081 | Charminade Mccoy | Physical Therapy Assistant | 1060 Playground Rd, Crestline, CA 92325 | 2016-04-01 |
| Find all providers in zip 92325 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427600451 | Joelle Jacobs | Marriage & Family Therapist | 340 Ca-138 Highway, Crestline, CA 92325 | 2019-07-10 |
| 1639732936 | Cecilia Maria Melendez | Marriage & Family Therapist | 24028 Lake Dr., Crestline, CA 92325-9232 | 2019-04-22 |
| 1245773217 | Rhonda Boss | Marriage & Family Therapist | 340 Hwy 138, Crestline, CA 92325-6300 | 2016-11-23 |
| 1326297979 | Cathleen Louise Love | Marriage & Family Therapist | 23739 Lake Dr., Suite 207, Crestline, CA 92325 | 2008-09-18 |
| 1013103068 | Linda J. Marcoux | Marriage & Family Therapist | 23451 Crest Forest Dr., Crestline, CA 92325 | 2007-09-22 |
| 1407903982 | Michael Beavers | Marriage & Family Therapist | 340 Highway 138, Crestline, CA 92325-6300 | 2007-01-05 |
| 1124047956 | Ginger Virginia Gabriel | Marriage & Family Therapist | 601 S Lee Bert Way, Crestline, CA 92325 | 2006-07-19 |
| 1528692977 | Magdalena Navarro Silva | Marriage & Family Therapist | 24028 Lake Dr., Crestline, CA 92325-9232 | 2020-02-25 |
| 1295390599 | Samuel Edward Baney | Marriage & Family Therapist | 340 Hwy 138, Crestline, CA 92325 | 2019-05-02 |
| 1275059222 | Victoria Greene | Marriage & Family Therapist | 24028 Lake Drive, Crestline, CA 92325 | 2017-08-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.