Healthcare Provider Details

I. General information

NPI: 1255475745
Provider Name (Legal Business Name): DOUGLAS GURLEY MHAII CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 FAIR OAKS BLVD
CARMICHAEL CA
95608-4818
US

IV. Provider business mailing address

1943 BELL ST APT 36
SACRAMENTO CA
95825-1034
US

V. Phone/Fax

Practice location:
  • Phone: 916-974-8090
  • Fax: 916-974-7851
Mailing address:
  • Phone: 916-459-9397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number03-093624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: