Healthcare Provider Details

I. General information

NPI: 1245371715
Provider Name (Legal Business Name): JOHN WAYNE GASSER MMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 NORTH PERKINS AVE
RUSHVILLE IN
46173
US

IV. Provider business mailing address

325 W 7TH ST
RUSHVILLE IN
46173-1511
US

V. Phone/Fax

Practice location:
  • Phone: 765-938-3817
  • Fax: 765-938-3972
Mailing address:
  • Phone: 765-938-3817
  • Fax: 765-938-3972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: