Healthcare Provider Details

I. General information

NPI: 1679615124
Provider Name (Legal Business Name): CHARLES L. GAYDOS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MESSIMER DR
NEWARK OH
43055-1874
US

IV. Provider business mailing address

65 MESSIMER DR
NEWARK OH
43055-1874
US

V. Phone/Fax

Practice location:
  • Phone: 740-788-3400
  • Fax: 740-788-3401
Mailing address:
  • Phone: 740-788-3400
  • Fax: 740-788-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0006101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: