Doctor Name: | MR. GARY DOUGLAS COUNSELMAN |
NPI Number: | 1508184730 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA,CT |
License Number: | |
Business Practice Address: | 129 Clark St Grove Hill, AL - 364513050 |
Business Phone Number: | 2512754165 |
Business Fax Number: | 2512754807 |
Mailing Address: | 129 Clark St, GROVE HILL |
State: | AL |
Postal Code: | 364513050 |
Phone Number: | 2512754165 |
Fax Number: | 2512754807 |
NPI Enumeration Date: | 05/12/2010 |
NPI Last Update Date: | 05/12/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |