Basic Information
| Provider Information | |||||||||
| NPI: | 1033253901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMMON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | ARTHUR | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC MS NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 MILWAUKEE ROAD | ||||||||
| Address2: | |||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083641181 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1969 W HART ROAD | ||||||||
| Address2: | |||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083645686 | ||||||||
| FaxNumber: | 6083635756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3191125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.