Provider Demographics
NPI:1558977686
Name:DEANN GOSSARD LLC
Entity Type:Organization
Organization Name:DEANN GOSSARD LLC
Other - Org Name:FUSE TRAUMA RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, LICDC
Authorized Official - Phone:419-277-5816
Mailing Address - Street 1:2735 N HOLLAND SYLVANIA RD STE A1
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1844
Mailing Address - Country:US
Mailing Address - Phone:419-315-6422
Mailing Address - Fax:833-381-0977
Practice Address - Street 1:2735 N HOLLAND SYLVANIA RD STE A1
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1844
Practice Address - Country:US
Practice Address - Phone:419-908-9769
Practice Address - Fax:833-381-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty