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General NPI Number Information
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NPI Number | 1043804750
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Entity Type | Organization
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Legal Business Name | GEMSWITHIN
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 756 N MADISON ST
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City | CROWN POINT
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State | IN
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Zip | 46307-8210
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Country | US
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Telephone | 219-779-0509
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Fax | 219-738-6714
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Provider Business Mailing Address
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Address Line | 756 N MADISON ST
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City | CROWN POINT
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State | IN
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Zip | 46307-8210
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Country | US
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Telephone | 219-779-0509
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Fax | 219-738-6714
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Authorized Official
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Title or Position | CREDENTIALING
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Name | LYNN MCDONALD
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Credential |
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Telephone | 219-769-1670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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