MEDICARE: MR. JOSHUA GASS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1679165997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSHUA GASS

Provider Business Mailing Address
First Line	:	1065 N 6TH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3669
Country	:	US
Telephone Number	:	504-875-6228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1065 N 6TH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3669
Country	:	US
Telephone Number	:	504-875-6228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	02/08/2021

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Directions to “ MR. JOSHUA GASS ” Practice Location

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