Healthcare Provider Details

I. General information

NPI: 1326065814
Provider Name (Legal Business Name): GWENYTH G OBRYAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 FLINT ST
RENO NV
89501
US

IV. Provider business mailing address

325 FLINT ST
RENO NV
89501
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-3339
  • Fax: 775-329-9935
Mailing address:
  • Phone: 775-329-3339
  • Fax: 775-329-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY048
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: