Provider Demographics
NPI:1992751184
Name:SCHAD, GREGORY M (LISW, IIMFT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:SCHAD
Suffix:
Gender:M
Credentials:LISW, IIMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N HIGH ST
Mailing Address - Street 2:STE 107
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3611
Mailing Address - Country:US
Mailing Address - Phone:614-263-8161
Mailing Address - Fax:614-263-8268
Practice Address - Street 1:3620 N HIGH ST
Practice Address - Street 2:STE 107
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3693
Practice Address - Country:US
Practice Address - Phone:614-263-8161
Practice Address - Fax:614-263-8268
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH976169101YA0400X
OHI-74681041C0700X
OHF105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist