Provider Demographics
NPI:1053610147
Name:ARTIS, GARY WAYNE
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:WAYNE
Last Name:ARTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 CORVALLIS CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-6057
Mailing Address - Country:US
Mailing Address - Phone:775-853-4767
Mailing Address - Fax:775-853-4625
Practice Address - Street 1:483 CORVALLIS CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-6057
Practice Address - Country:US
Practice Address - Phone:775-853-4767
Practice Address - Fax:775-853-4625
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health