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IAN JONAS KEENE GERHARD LMHC

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1629642145

Individual Registrant:
 IAN JONAS KEENE GERHARD LMHC
Gender: M
Sole Proprietor

Location and contact information for practice:
10763 STANDING STONE DR  WIMAUMA, FL 33598-6164 US
Tel: 813-758-2642  Fax: --

Contact information for business:
10763 STANDING STONE DR  WIMAUMA, FL 33598-6164 US
Tel: 813-758-2642  Fax: --

Registration Information:
NPI: 1629642145
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
FLMH19065

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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