Individual
GARY SCOTT RALYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2121 E STATE BLVD, FORT WAYNE, IN 46805-4640
(260) 426-5431
Mailing address
5646 LAKE AVE, FORT WAYNE, IN 46815-7564
(260) 450-5683
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34002338A
IN
Other
Enumeration date
07/08/2020
Last updated
07/08/2020
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