Provider Demographics
NPI:1225199227
Name:GESSNER, JAMES CLARK (ADDICTION SPECIALIST)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CLARK
Last Name:GESSNER
Suffix:
Gender:M
Credentials:ADDICTION SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9555 CHIPPEWA TRAIL
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-9555
Mailing Address - Country:US
Mailing Address - Phone:707-277-0881
Mailing Address - Fax:707-994-7164
Practice Address - Street 1:7000 SOUTH CENTER DR
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-7000
Practice Address - Country:US
Practice Address - Phone:707-994-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0402270902101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)