Provider Demographics
NPI:1417072646
Name:TURSIC, GAYLE S (LPCC, IMFT, LSW)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:S
Last Name:TURSIC
Suffix:
Gender:F
Credentials:LPCC, IMFT, LSW
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:S
Other - Last Name:HITCHCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, IMFT, LSW
Mailing Address - Street 1:4334 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4234
Mailing Address - Country:US
Mailing Address - Phone:419-475-4449
Mailing Address - Fax:419-479-3230
Practice Address - Street 1:4334 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4234
Practice Address - Country:US
Practice Address - Phone:419-475-4449
Practice Address - Fax:419-479-3230
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002346101YP2500X
OHS0016831104100000X
OHF0500013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist