Provider Demographics
NPI:1700424355
Name:GARY, MARGARET ASHLEY (LPC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ASHLEY
Last Name:GARY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 OLD HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-3587
Mailing Address - Country:US
Mailing Address - Phone:731-203-1011
Mailing Address - Fax:731-658-1597
Practice Address - Street 1:641 E POPLAR AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1828
Practice Address - Country:US
Practice Address - Phone:731-645-5753
Practice Address - Fax:731-645-9885
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional