Provider Demographics
NPI:1275684581
Name:ECHT, GARY MARK (LPCC LICDC SAP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MARK
Last Name:ECHT
Suffix:
Gender:M
Credentials:LPCC LICDC SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28916 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2531
Mailing Address - Country:US
Mailing Address - Phone:440-944-6565
Mailing Address - Fax:440-944-0489
Practice Address - Street 1:28916 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2531
Practice Address - Country:US
Practice Address - Phone:440-944-6565
Practice Address - Fax:440-944-0489
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0002461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health