Provider Demographics
NPI:1700311461
Name:GAYAN, JOSEPH PAUL (LPC-IT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:GAYAN
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9188
Mailing Address - Country:US
Mailing Address - Phone:920-540-1365
Mailing Address - Fax:
Practice Address - Street 1:619 RIVER ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9188
Practice Address - Country:US
Practice Address - Phone:920-540-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional