Healthcare Provider Details

I. General information

NPI: 1740452598
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL GAULT L.P.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MULL AVE
AKRON OH
44313-7502
US

IV. Provider business mailing address

430 IOWA AVE
MC DONALD OH
44437-1926
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-5603
  • Fax: 330-873-3439
Mailing address:
  • Phone: 330-530-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0500975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: