Individual
DR. GARY NUNNALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, DMIN
Contact information
Practice address
8202 CLEARVISTA PKWY, BLDG 7, INDIANAPOLIS, IN 46256-1400
(317) 288-9942
(317) 288-9945
Mailing address
8202 CLEARVISTA PKWY, BLDG 7, INDIANAPOLIS, IN 46256-1400
(317) 288-9942
(317) 288-9945
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
34002418A
IN
1041C0700X
Clinical Social Worker
Primary
34002418A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100381890
—
IN
Enumeration date
12/05/2005
Last updated
11/06/2018
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