Healthcare Provider Details

I. General information

NPI: 1669689089
Provider Name (Legal Business Name): PAUL GESSFORD MFT MAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 02/25/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 N HWY 89
ALPINE WY
83128
US

IV. Provider business mailing address

PO BOX 3146
ALPINE WY
83128-0146
US

V. Phone/Fax

Practice location:
  • Phone: 307-654-2226
  • Fax:
Mailing address:
  • Phone: 307-654-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMAC NAADAC 507070
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAT367
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0611
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT207
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: