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General NPI Number Information
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NPI Number | 1801453477
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Entity Type | Individual
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Provider Name | BRYAN GASTELLE PSYD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 1222 W BASELINE RD UNIT 154
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City | TEMPE
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State | AZ
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Zip | 85283-5967
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Country | US
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Telephone | 480-524-0990
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Fax | 480-436-6720
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Provider Business Mailing Address
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Address Line | 1222 W BASELINE RD UNIT 154
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City | TEMPE
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State | AZ
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Zip | 85283-5967
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Country | US
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Telephone | 301-471-6944
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Fax | 480-436-6720
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS018947
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-005446
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License Number State | AZ
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