Provider Demographics
NPI:1013936509
Name:CONWAY, GARY LEE (LMHC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:CONWAY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8935 N MERIDIAN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5379
Mailing Address - Country:US
Mailing Address - Phone:317-571-0170
Mailing Address - Fax:317-571-2005
Practice Address - Street 1:8935 N MERIDIAN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5379
Practice Address - Country:US
Practice Address - Phone:317-571-0170
Practice Address - Fax:317-571-2005
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN39001643A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health