Provider Demographics
NPI:1669682050
Name:REISS, GUNTER (MFCC)
Entity Type:Individual
Prefix:
First Name:GUNTER
Middle Name:
Last Name:REISS
Suffix:
Gender:M
Credentials:MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 NEVADA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2895
Mailing Address - Country:US
Mailing Address - Phone:909-793-8312
Mailing Address - Fax:909-792-6507
Practice Address - Street 1:1210 NEVADA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2895
Practice Address - Country:US
Practice Address - Phone:909-793-8312
Practice Address - Fax:909-792-6507
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist