MEDICARE: MR. CURTIS GILLESPIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.964481	OH
2	101YP2500X	Professional Counselor	E.0001350-SUPV	OH
3	1041C0700X	Clinical Social Worker	I.0001981-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197082000	OTHER	OH	MAGELLAN
2	000000004375	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1134110117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CURTIS GILLESPIE

Provider Business Mailing Address
First Line	:	2475 WICKLIFFE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-1835
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3162 EL CAMINO DR
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-1318
Country	:	US
Telephone Number	:	937-342-9030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	06/24/2019

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Directions to “ MR. CURTIS GILLESPIE ” Practice Location

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