Gregory John Wightman, L.P.C.C. SUPV.

Primary specialty

CounselorTaxonomy code 101Y00000X

License

E0000394 SUPV Issued in OH

Practice address

2611 Wayne Ave
Building #66
Dayton, OH 45420-1833

Phone

(937) 258-0440

Fax

(937) 258-6235

NPI assigned

Dec 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of Ohio Department of Mental Health

  • Case Management Agency
  • Dayton, OH
  • NPI 1750350658
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073672275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E BROAD ST",
            "address_2": "11TH FLOOR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432153414",
            "telephone_number": "614-466-6583",
            "fax_number": "614-995-3268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 WAYNE AVE",
            "address_2": "BUILDING #66",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454201833",
            "telephone_number": "937-258-0440",
            "fax_number": "937-258-6235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIGHTMAN",
        "first_name": "GREGORY",
        "middle_name": "JOHN",
        "credential": "L.P.C.C. SUPV.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "E0000394 SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bratiena Wiggins
• Elaine Mary Wiggins
• Frank Wiggins
• Natasha Wiggins, LSW
• Melissa Wigginton, QMHS/CMS
• John R Wigneswaran, MD
• Abigayle Lynette Wilbanks, M.A. CCC-SLP
• Jeffrey Robert Wilbert, PH.D.
• Tishawna Wilborn
• Marsha Ann Wilburn, P.N.

• Counselor in Dayton, OH
• Providers in Dayton, OH by specialty
• Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.