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General NPI Number Information
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NPI Number | 1154847424
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Entity Type | Organization
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Legal Business Name | GATEWAY COUNSELING INCORPORATED
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 7114 GALEN DR W STE 103
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City | AVON
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State | IN
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Zip | 46123-8659
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Country | US
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Telephone | 317-590-6139
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Fax |
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Provider Business Mailing Address
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Address Line | 8103 E US HIGHWAY 36 # 243
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City | AVON
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State | IN
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Zip | 46123-7964
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS COLGROVE
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Credential | MS, LSW
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Telephone | 317-590-6139
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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 | 39002164A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 33003053A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39000854A
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License Number State | IN
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