Provider Demographics
NPI:1811007792
Name:GWEN OBRYAN PHD LTD
Entity Type:Organization
Organization Name:GWEN OBRYAN PHD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-329-3339
Mailing Address - Street 1:325 FLINT STREET
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501
Mailing Address - Country:US
Mailing Address - Phone:775-329-3339
Mailing Address - Fax:775-329-9935
Practice Address - Street 1:325 FLINT STREET
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501
Practice Address - Country:US
Practice Address - Phone:775-329-3339
Practice Address - Fax:775-329-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36124Medicare ID - Type Unspecified