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General NPI Number Information
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NPI Number | 1912020876
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Entity Type | Organization
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Legal Business Name | GARY D. ACKERLEY, INC.
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Dates
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Enumeration Date | 04/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 305 E STROOP RD
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City | DAYTON
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State | OH
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Zip | 45429-2827
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Country | US
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Telephone | 937-640-1432
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Fax | 937-294-3320
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Provider Business Mailing Address
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Address Line | 305 E STROOP RD
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City | DAYTON
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State | OH
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Zip | 45429-2827
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Country | US
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Telephone | 937-640-1432
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Fax | 937-294-3320
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY D. ACKERLEY
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Credential | PH.D.,ABPP
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Telephone | 937-640-1432
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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 | 2853
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License Number State | OH
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