Provider Demographics
NPI:1841387024
Name:MCGUIRE, GARY RICHARD (MFT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:RICHARD
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 ADAMS ST
Mailing Address - Street 2:SUITE B30-18
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-4335
Mailing Address - Country:US
Mailing Address - Phone:951-237-4703
Mailing Address - Fax:951-681-3993
Practice Address - Street 1:2900 ADAMS ST
Practice Address - Street 2:SUITE B30-18
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4335
Practice Address - Country:US
Practice Address - Phone:951-237-4703
Practice Address - Fax:951-681-3993
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33BGANMedicaid
CA33BGONMedicaid