Provider Demographics
NPI:1225199524
Name:GANTT, MILTON JAY II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MILTON
Middle Name:JAY
Last Name:GANTT
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 GULFTON ST
Mailing Address - Street 2:STE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1107
Mailing Address - Country:US
Mailing Address - Phone:713-457-4372
Mailing Address - Fax:
Practice Address - Street 1:6315 GULFTON ST
Practice Address - Street 2:STE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1107
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256671041C0700X, 101Y00000X
TX220041512171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25667OtherSOCIAL WORK LICENSE
TXTXB137050Medicare PIN