Provider Demographics
NPI:1457440844
Name:GULLION, GUY R (M D)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:R
Last Name:GULLION
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PLEASANT HILL AVE N
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3164
Mailing Address - Country:US
Mailing Address - Phone:707-329-6943
Mailing Address - Fax:
Practice Address - Street 1:120 PLEASANT HILL AVE N
Practice Address - Street 2:SUITE 340
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3164
Practice Address - Country:US
Practice Address - Phone:707-329-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0502842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry