Provider Demographics
NPI:1659422178
Name:GADDIS, JOHN W (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:GADDIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 MIRAMAR LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2629
Mailing Address - Country:US
Mailing Address - Phone:805-969-0749
Mailing Address - Fax:
Practice Address - Street 1:1136 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3114
Practice Address - Country:US
Practice Address - Phone:805-564-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor