Provider Demographics
NPI:1255834412
Name:GORRELL COUNSELING LLC
Entity Type:Organization
Organization Name:GORRELL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CARR
Authorized Official - Last Name:GORRELL
Authorized Official - Suffix:II
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:330-447-4351
Mailing Address - Street 1:4501 HILLS AND DALES RD NW STE 202
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1572
Mailing Address - Country:US
Mailing Address - Phone:330-447-0746
Mailing Address - Fax:
Practice Address - Street 1:4501 HILLS AND DALES RD NW STE 202
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1572
Practice Address - Country:US
Practice Address - Phone:330-447-0746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1600089-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty