Basic Information
| Provider Information | |||||||||
| NPI: | 1760996763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUGSLEY | ||||||||
| FirstName: | DAN | ||||||||
| MiddleName: | GAYLE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3750 SUGAR CREEK RD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458079527 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1751 E LONG ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432032045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142538050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2017 | ||||||||
| LastUpdateDate: | 08/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1701073 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | I.2002196 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.