Provider Demographics
NPI:1740452598
Name:GAULT, CHRISTOPHER MICHAEL (LPCC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:GAULT
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:OH
Mailing Address - Zip Code:44437-1926
Mailing Address - Country:US
Mailing Address - Phone:330-530-5980
Mailing Address - Fax:
Practice Address - Street 1:900 MULL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7502
Practice Address - Country:US
Practice Address - Phone:330-867-5603
Practice Address - Fax:330-873-3439
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional