Provider Demographics
NPI:1326065814
Name:OBRYAN, GWENYTH G (PHD)
Entity Type:Individual
Prefix:
First Name:GWENYTH
Middle Name:G
Last Name:OBRYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 FLINT ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501
Mailing Address - Country:US
Mailing Address - Phone:775-329-3339
Mailing Address - Fax:775-329-9935
Practice Address - Street 1:325 FLINT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501
Practice Address - Country:US
Practice Address - Phone:775-329-3339
Practice Address - Fax:775-329-9935
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV36124OtherMEDICARE CORPORATION
NV36124OtherMEDICARE CORPORATION