| Gary D. Stanforth,ltd.,msw.,lisw.,licdc | |
|
8401 Claude Thomas Rd Suite 21 F Franklin OH 45005-1497 | |
| (515) 535-7668 | |
| (937) 704-0255 |
| Full Name | Gary D. Stanforth,ltd.,msw.,lisw.,licdc |
|---|---|
| Speciality | Counselor |
| Location | 8401 Claude Thomas Rd, Franklin, Ohio |
| Authorized Official Name and Position | Gary D. Stanforth (ADDICTIONS/MENTAL HEALTH COUNSELOR) |
| Authorized Official Contact | 5135357668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary D. Stanforth,ltd.,msw.,lisw.,licdc 9733 Debold Koebel Rd Pleasant Plain OH 45162-9353 Ph: (513) 535-7668 | Gary D. Stanforth,ltd.,msw.,lisw.,licdc 8401 Claude Thomas Rd Suite 21 F Franklin OH 45005-1497 Ph: (515) 535-7668 |
| NPI Number | 1700966942 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 01/15/2009 |
| Medicare PECOS PAC ID | 1951308659 |
|---|---|
| Medicare Enrollment ID | O20061020000554 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700966942 | NPI | - | NPPES |
| 06282065 | Other | OH | MEDICARE PCN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Gary D Stanforth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538255534 PECOS PAC ID: 4981600095 Enrollment ID: I20061012000682 |
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