Provider Demographics
NPI:1710414289
Name:CLEMENTS, GREGORY ALLEN (LMHCA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLEN
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 13TH ST STE 2520
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1312
Mailing Address - Country:US
Mailing Address - Phone:812-376-6501
Mailing Address - Fax:
Practice Address - Street 1:1531 13TH ST STE 2520
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1312
Practice Address - Country:US
Practice Address - Phone:812-376-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001332A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health