Provider Demographics
NPI:1942908686
Name:GC THERAPY LAKE CITY, INC
Entity Type:Organization
Organization Name:GC THERAPY LAKE CITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:386-397-4883
Mailing Address - Street 1:1415 OHIO AVE N UNIT 177
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-7960
Mailing Address - Country:US
Mailing Address - Phone:386-397-4883
Mailing Address - Fax:888-841-9040
Practice Address - Street 1:328 SW ALACHUA AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7021
Practice Address - Country:US
Practice Address - Phone:386-438-5864
Practice Address - Fax:888-841-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty