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General NPI Number Information
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NPI Number | 1518150697
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Entity Type | Organization
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Legal Business Name | CHARLES E. GERLACH, PH.D & ASSOCIATES
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 4700 REED RD STE C
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City | COLUMBUS
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State | OH
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Zip | 43220-3074
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Country | US
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Telephone | 614-442-1300
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Fax | 614-442-1308
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Provider Business Mailing Address
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Address Line | 4700 REED RD STE C
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City | COLUMBUS
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State | OH
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Zip | 43220-3074
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Country | US
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Telephone | 614-442-1300
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Fax | 614-442-1308
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | CHARLES EDWIN GERLACH
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Credential | PH.D
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Telephone | 614-442-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3978
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License Number State | OH
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