Individual
GARY WAYNE TICEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6605 W CENTRAL AVE, TOLEDO, OH 43617-1000
(419) 841-7701
Mailing address
2005 ASHLAND AVE, TOLEDO, OH 43620-1703
(419) 841-7701
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
165227
OH
175T00000X
Peer Specialist
—
—
Other
Enumeration date
12/27/2017
Last updated
11/03/2023
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