Individual provider Active NPI

John M Gill, LPCC'S

  • Professional Counselor
  • Canton, OH
National Provider Identifier
1104935170
Registry record updated Apr 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E4358 Issued in OH
Practice address
624 Market Ave N
Canton, OH 44702-1017
Phone
(330) 493-4553
Fax
(330) 493-3761
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X E4358 OH Primary
Clinical Social Worker 1041C0700X S0016960 OH

Addresses

Primary practice location

624 Market Ave N
Canton, OH 44702-1017

Mailing address

624 Market Ave N
Canton, OH 44702-1017
Phone (330) 493-4553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240730000404 OH Practitioner - Mental Health Counselor 3971821893 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E4358OHMDProfessional Counselor
S0016960OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Coleman Professional Services, Inc. Professional CurrentSince May 28, 2024 Accepting new patients

Locations

624 Market Ave N
Canton, OH 44702
Phone (330) 454-7066

2421 13th St NW
Canton, OH 44708
Phone (330) 452-6000

5982 Rhodes Rd
Kent, OH 44240
Phone (330) 676-6875

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460678400000",
    "number": "1104935170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021017",
            "telephone_number": "330-493-4553",
            "fax_number": "330-493-3761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021017",
            "telephone_number": "330-493-4553",
            "fax_number": "330-493-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILL",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "LPCC'S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2016-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E4358",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S0016960",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.