Provider Demographics
NPI:1295617991
Name:GOMEZ, ALLISON BELLE
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:BELLE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 HARLAN ST APT 103
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3538
Mailing Address - Country:US
Mailing Address - Phone:510-483-9413
Mailing Address - Fax:
Practice Address - Street 1:2301 HYPERION AVE # A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-4711
Practice Address - Country:US
Practice Address - Phone:310-879-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist