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General NPI Number Information
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NPI Number | 1588183453
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Entity Type | Individual
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Provider Name | GREGORY SOUTHARD LPCC-S, IMFT
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Gender | Male
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 960 GRAHAM RD. UNIT 3
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44221
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Country | US
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Telephone | 330-606-9262
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Fax |
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Provider Business Mailing Address
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Address Line | 960 GRAHAM RD., UNIT 3
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44221
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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 |
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Name |
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Credential |
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Telephone |
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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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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M1900095
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | F.2100158
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.2001739
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License Number State | OH
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