Provider Demographics
NPI:1275923658
Name:GOSSARD, DEANN (LPCC)
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:
Last Name:GOSSARD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12753 LULU RD
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:MI
Mailing Address - Zip Code:48140-9524
Mailing Address - Country:US
Mailing Address - Phone:419-315-6422
Mailing Address - Fax:
Practice Address - Street 1:126 W FRONT ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1465
Practice Address - Country:US
Practice Address - Phone:419-315-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1700119101YP2500X
OHE.1700119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional