Individual
GREGORY SOUTHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IMFT-S, LPCC-S
Contact information
Practice address
4522 FULTON DR NW, CANTON, OH 44718-2332
(330) 915-2907
(330) 915-2958
Mailing address
4522 FULTON DR NW, CANTON, OH 44718-2332
(330) 915-2907
(330) 915-2958
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
E.2001739
OH
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
F.2100158
OH
106H00000X
Marriage & Family Therapist
Primary
F.2100158-SUPV
OH
106H00000X
Marriage & Family Therapist
M1900095
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0284116
—
OH
Enumeration date
09/12/2017
Last updated
04/29/2026
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