Individual ProviderGary L MolineMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address73 Saint James Dr, Santa Rosa, CA 95403-1419(707) 571-1714PECOS EnrollmentBased on the most recent information from CMS, provider Gary L Moline does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1518176643Provider TypeIndividualFull NameMoline, Gary LTitleMr.CredentialMFTGenderMaleSole ProprietorYesEnumeration Date5/22/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address73 Saint James Dr, Santa Rosa, CA 95403-1419Phone(707) 571-1714FaxUnlisted FaxMailing LocationMailing Address73 Saint James Dr, Santa Rosa, CA 95403-1419Phone(707) 571-1714FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseMFC 015483California