Healthcare Provider Details

I. General information

NPI: 1659511012
Provider Name (Legal Business Name): STEPHEN C. GAMBLIN BCSI, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 11/27/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 S MONTCLAIR AVE
BLOOMINGTON IN
47401-6814
US

IV. Provider business mailing address

2112 S MONTCLAIR AVE
BLOOMINGTON IN
47401-6814
US

V. Phone/Fax

Practice location:
  • Phone: 812-330-0789
  • Fax:
Mailing address:
  • Phone: 812-330-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT20902052
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: