Provider Demographics
NPI:1164131538
Name:GAZOO COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:GAZOO COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZOO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:570-983-4047
Mailing Address - Street 1:501 WARD ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2427
Mailing Address - Country:US
Mailing Address - Phone:570-983-4047
Mailing Address - Fax:
Practice Address - Street 1:501 WARD ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2427
Practice Address - Country:US
Practice Address - Phone:570-983-4047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty