Provider Demographics
NPI:1174542641
Name:GARY, JOHN JOSEPH (MS, PCC, PHD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:GARY
Suffix:
Gender:M
Credentials:MS, PCC, PHD
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:J
Other - Last Name:GARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PCC, PHD
Mailing Address - Street 1:230 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3762
Mailing Address - Country:US
Mailing Address - Phone:614-846-8800
Mailing Address - Fax:614-846-8800
Practice Address - Street 1:230 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3762
Practice Address - Country:US
Practice Address - Phone:614-846-8800
Practice Address - Fax:614-846-8800
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health