Provider Demographics
NPI:1457354912
Name:GUSS, P. GREGORY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:P. GREGORY
Middle Name:
Last Name:GUSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 PORTAGE BAY E
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3073
Mailing Address - Country:US
Mailing Address - Phone:530-758-2794
Mailing Address - Fax:530-758-9869
Practice Address - Street 1:2655 PORTAGE BAY E
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3073
Practice Address - Country:US
Practice Address - Phone:530-758-2794
Practice Address - Fax:530-758-9869
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS74511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical