Provider Demographics
NPI:1033448568
Name:GAY, CHRISTOPHER LEE (RS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:GAY
Suffix:
Gender:M
Credentials:RS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:26350 DELANO DR.
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549-0219
Mailing Address - Country:US
Mailing Address - Phone:951-659-8704
Mailing Address - Fax:
Practice Address - Street 1:960 N STATE ST STE B
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1400
Practice Address - Country:US
Practice Address - Phone:951-652-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA333901Medicaid
CA333903Medicaid