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Individual
GARY WAYNE TICEY
Active
Individual
GARY WAYNE TICEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
171M00000X
Case Manager/Care Coordinator
165227
OH
175T00000X
Peer Specialist
—
NULL
Other
Enumeration date
12/27/2017
Last updated
11/03/2023
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