Provider Demographics
NPI:1982628863
Name:SAHLY, GARY JOHN (MFT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:JOHN
Last Name:SAHLY
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 1:6076 PENTZ RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5541
Mailing Address - Country:US
Mailing Address - Phone:530-872-0405
Mailing Address - Fax:530-876-1700
Practice Address - Street 1:6076 PENTZ RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5541
Practice Address - Country:US
Practice Address - Phone:530-872-0405
Practice Address - Fax:530-876-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC14265OtherMARRAIGE FAMILY THERAPIST