Active NPI
John M Gill, LPCC'S
- Professional Counselor
- Canton, OH
National Provider Identifier
1104935170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E4358
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E4358 | OH | MD | Professional Counselor |
| S0016960 | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coleman Professional Services, Inc. | Professional | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.