=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669689089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL GESSFORD MFT MAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 N HWY 89
-----------------------------------------------------
City | ALPINE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 83128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-654-2226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3146
-----------------------------------------------------
City | ALPINE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 83128-0146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-654-2226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | MAC NAADAC 507070
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LAT367
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 0611
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT207
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------