Healthcare Provider Details

I. General information

NPI: 1710414289
Provider Name (Legal Business Name): GREGORY ALLEN CLEMENTS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 NORTHWOOD PLZ
FRANKLIN IN
46131-1037
US

IV. Provider business mailing address

1860 NORTHWOOD PLZ
FRANKLIN IN
46131-1037
US

V. Phone/Fax

Practice location:
  • Phone: 463-269-4410
  • Fax:
Mailing address:
  • Phone: 463-269-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004714A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: