Provider Demographics
NPI:1447036769
Name:BAYLOR, GABRIELLE (APCC)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:BAYLOR
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:LYNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 TRANSPORT WAY STE 20
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:921 TRANSPORT WAY STE 20
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1464
Practice Address - Country:US
Practice Address - Phone:707-835-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC14313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health