Provider Demographics
NPI:1932649639
Name:ZORNES, GARY W (LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:ZORNES
Suffix:
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 1:1056 WELLINGTON WAY STE 160
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-2002
Mailing Address - Country:US
Mailing Address - Phone:859-785-4599
Mailing Address - Fax:606-796-6221
Practice Address - Street 1:910 KENTON STATION DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9613
Practice Address - Country:US
Practice Address - Phone:606-759-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1.20023191041C0700X
IN34007629A1041C0700X
KY2524501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100475410Medicaid