Provider Demographics
NPI:1669689089
Name:GESSFORD, PAUL (MFT MAC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GESSFORD
Suffix:
Gender:M
Credentials:MFT MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5627
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89450-5627
Mailing Address - Country:US
Mailing Address - Phone:775-833-1003
Mailing Address - Fax:
Practice Address - Street 1:880 NORTHWOOD BLVD STE 4
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-8249
Practice Address - Country:US
Practice Address - Phone:775-833-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMAC NAADAC 507070101YA0400X
NVLADC 930101YA0400X
NV0611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist