Provider Demographics
NPI:1457387763
Name:GUTRIDE, MARTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:GUTRIDE
Suffix:
Gender:M
Credentials:PHD
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 7057
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89510-7057
Mailing Address - Country:US
Mailing Address - Phone:775-323-1200
Mailing Address - Fax:775-323-2911
Practice Address - Street 1:1699 S VIRGINIA ST
Practice Address - Street 2:SUITE 203
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2820
Practice Address - Country:US
Practice Address - Phone:775-323-1200
Practice Address - Fax:775-323-2911
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002616013Medicaid