# GARY D. STANFORTH,LTD.,MSW.,LISW.,LICDC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700966942
- **Authorized official:** MR. GARY D. STANFORTH L.I.S.W, L.I.C.D.C. (ADDICTIONS/MENTAL HEALTH COUNSELOR)
- **Authorized official phone:** (513) 535-7668

## Contact information

- **Practice address:** 8401 CLAUDE THOMAS RD, SUITE 21 F, FRANKLIN, OH 45005-1497
- **Practice address phone:** (515) 535-7668
- **Practice address fax:** (937) 704-0255
- **Mailing address:** 9733 DEBOLD KOEBEL RD, PLEASANT PLAIN, OH 45162-9353
- **Mailing address phone:** (513) 535-7668
- **Mailing address fax:** (937) 704-0255

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 01/15/2009