Provider Demographics
NPI:1902940216
Name:ACOSTA, GILBERT A (MA)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:A
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 BECHELLI LN STE G
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2461
Mailing Address - Country:US
Mailing Address - Phone:530-768-5620
Mailing Address - Fax:530-768-5621
Practice Address - Street 1:3464 BECHELLI LN STE G
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2461
Practice Address - Country:US
Practice Address - Phone:530-768-5620
Practice Address - Fax:530-768-5621
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist