MEDICARE: PHILLIP W GRAMLING LPC

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	2369	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2369	OTHER	AL	LPC

General Provider Information

NPI Number	:	1780684746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP W GRAMLING LPC

Provider Business Mailing Address
First Line	:	118 OAK CIR
Second Line	:
City	:	GADSDEN
State	:	AL
Zip	:	35901-5814
Country	:	US
Telephone Number	:	256-393-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 CHURCH ST
Second Line	:	SUITE B
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6242
Country	:	US
Telephone Number	:	256-393-1888
Fax Number	:

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	06/20/2011

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Directions to “ PHILLIP W GRAMLING LPC” Practice Location

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