Provider Information for 1417174285
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RICHARD PHILLIP GANTT LPCC
Sex: Male
NPI: 1417174285
Last Updated: 2024-03-15
Certification Date: 2024-03-15
Certification Date: 2024-03-15
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1417174285 | ||||||||||||
| Enumeration Date | 2007-04-20 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 104 S FRONT AVE PRESTONSBURG, KY 41653-1614 United States Phone: 606-886-8572 | Fax: | ||||||||||||
| Primary Practice Address | 104 S FRONT AVE PRESTONSBURG, KY 41653-1614 United States Phone: 606-886-8572 | Fax: | ||||||||||||
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