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General NPI Number Information
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NPI Number | 1629222013
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Entity Type | Organization
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Legal Business Name | EATING DISORDER RECOVERY SERVICES PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 5365 MAE ANNE AVE SUITE B-10
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City | RENO
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State | NV
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Zip | 89523-1840
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Country | US
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Telephone | 775-287-2706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2866
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City | RENO
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State | NV
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Zip | 89505-2866
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Country | US
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Telephone | 775-287-2706
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL FREDERICK GUNNARSON
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Credential | PH.D.
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Telephone | 775-287-2706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0360
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License Number State | NV
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