Provider Demographics
NPI:1841207164
Name:GAMSON, LELAND PAUL (LCSW)
Entity type:Individual
Prefix:MR
First Name:LELAND
Middle Name:PAUL
Last Name:GAMSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 W SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3425
Mailing Address - Country:US
Mailing Address - Phone:765-664-5503
Mailing Address - Fax:765-664-5503
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:NIHCS, MARION VA HOSPITAL
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4568
Practice Address - Country:US
Practice Address - Phone:765-674-3321
Practice Address - Fax:765-677-5115
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN43000194A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical