Provider Demographics
NPI:1407872609
Name:WYTRYKUS, GAYNELL ANDREWS (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAYNELL
Middle Name:ANDREWS
Last Name:WYTRYKUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GAYE
Other - Middle Name:
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:490 SIERRA KEYS DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1046
Mailing Address - Country:US
Mailing Address - Phone:626-355-6815
Mailing Address - Fax:
Practice Address - Street 1:490 SIERRA KEYS DR
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1046
Practice Address - Country:US
Practice Address - Phone:626-355-7025
Practice Address - Fax:626-355-7025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist