Organization
GARY D. STANFORTH,LTD.,MSW.,LISW.,LICDC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY D. STANFORTH L.I.S.W, L.I.C.D.C. (ADDICTIONS/MENTAL HEALTH COUNSELOR)
(513) 535-7668
Entity
Organization
Contact information
Practice address
8401 CLAUDE THOMAS RD, SUITE 21 F, FRANKLIN, OH 45005-1497
(515) 535-7668
(937) 704-0255
Mailing address
9733 DEBOLD KOEBEL RD, PLEASANT PLAIN, OH 45162-9353
(513) 535-7668
(937) 704-0255
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06282065
MEDICARE PCN
OH
Enumeration date
10/16/2006
Last updated
01/15/2009
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