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NPI Code Detail

MEDICARE: DOUGLAS GURLEY MHAII CAS

MEDICARE: DOUGLAS GURLEY MHAII CAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor03-093624CA

General Provider Information

NPI Number : 1255475745
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS GURLEY MHAII CAS
Provider Business Mailing Address
First Line : 1943 BELL ST APT 36
Second Line :
City : SACRAMENTO
State : CA
Zip : 95825-1034
Country : US
Telephone Number : 916-459-9397
Fax Number :
Provider Business Practice Location Address
First Line : 6127 FAIR OAKS BLVD
Second Line :
City : CARMICHAEL
State : CA
Zip : 95608-4818
Country : US
Telephone Number : 916-974-8090
Fax Number : 916-974-7851
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 01/10/2012

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