Provider Demographics
NPI:1962205823
Name:GAULT, KEVIN (BA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:GAULT
Suffix:
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 MERCER AVE
Mailing Address - Street 2:
Mailing Address - City:FARRELL
Mailing Address - State:PA
Mailing Address - Zip Code:16121-2505
Mailing Address - Country:US
Mailing Address - Phone:724-679-2242
Mailing Address - Fax:724-981-2293
Practice Address - Street 1:1914 MERCER AVE
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-2505
Practice Address - Country:US
Practice Address - Phone:724-981-9815
Practice Address - Fax:724-981-2293
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)