Provider Demographics
NPI:1356668578
Name:DRAWHORN, GAILAND RUTH (PHD, DMIN, MED)
Entity Type:Individual
Prefix:DR
First Name:GAILAND
Middle Name:RUTH
Last Name:DRAWHORN
Suffix:
Gender:F
Credentials:PHD, DMIN, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 HANCOCK RD STE 301
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5948
Mailing Address - Country:US
Mailing Address - Phone:928-763-7008
Mailing Address - Fax:928-758-4632
Practice Address - Street 1:1225 HANCOCK RD STE 301
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5948
Practice Address - Country:US
Practice Address - Phone:928-763-7008
Practice Address - Fax:928-758-4632
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INWAITING FOR TEST DAT103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INWAITING FOR NUMBEROtherICAADA MEMBER (THIS IS A NEW BUSINESS. WE ARE IN THE PROCESS OF APPLYING TO ALL