Provider Demographics
NPI:1508184730
Name:COUNSELMAN, GARY DOUGLAS (MA,CT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DOUGLAS
Last Name:COUNSELMAN
Suffix:
Gender:M
Credentials:MA,CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451-3050
Mailing Address - Country:US
Mailing Address - Phone:251-275-4165
Mailing Address - Fax:251-275-4807
Practice Address - Street 1:129 CLARK ST
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451-3050
Practice Address - Country:US
Practice Address - Phone:251-275-4165
Practice Address - Fax:251-275-4807
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health