Provider Demographics
NPI:1245602036
Name:LLOYD, GARY (MS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:LLOYD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 1/2 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3610
Mailing Address - Country:US
Mailing Address - Phone:515-277-2205
Mailing Address - Fax:515-277-2181
Practice Address - Street 1:3832 1/2 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3610
Practice Address - Country:US
Practice Address - Phone:515-277-2205
Practice Address - Fax:515-277-2181
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1315101YA0400X
IA00745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA353194000Medicaid