Provider Demographics
NPI:1902073935
Name:GEHRUNG, JOHN PHILIP (CATC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PHILIP
Last Name:GEHRUNG
Suffix:
Gender:M
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22840 ANTELOPE BLVD
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-8874
Mailing Address - Country:US
Mailing Address - Phone:530-527-7893
Mailing Address - Fax:530-527-0766
Practice Address - Street 1:22840 ANTELOPE BLVD
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-8874
Practice Address - Country:US
Practice Address - Phone:530-527-7893
Practice Address - Fax:530-527-0766
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAADE970154101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)