MEDICARE: GREGORY ALLEN CLEMENTS LMHCA

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	101YM0800X	Mental Health Counselor	88001332A	IN

General Provider Information

NPI Number	:	1710414289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY ALLEN CLEMENTS LMHCA

Provider Business Mailing Address
First Line	:	1531 13TH ST STE 2520
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-1312
Country	:	US
Telephone Number	:	812-376-6501
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 13TH ST STE 2520
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-1312
Country	:	US
Telephone Number	:	812-376-6501
Fax Number	:

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

Provider Enumeration Date	:	05/16/2017
Last Update Date	:	04/27/2021

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