Provider Demographics
NPI:1275779126
Name:MC GEE, GERALD WISTA II (LISW-S)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:WISTA
Last Name:MC GEE
Suffix:II
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 E 222ND ST RM 205
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1718
Mailing Address - Country:US
Mailing Address - Phone:216-647-1411
Mailing Address - Fax:216-273-7887
Practice Address - Street 1:5311 NORTHFIELD RD
Practice Address - Street 2:SUITE #409
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146
Practice Address - Country:US
Practice Address - Phone:216-518-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0800373103K00000X
OHI08003731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst