Provider Demographics
NPI:1780014811
Name:GOSSAGE, JOE THOMAS JR (LPC/MHSP)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:THOMAS
Last Name:GOSSAGE
Suffix:JR
Gender:M
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 COURT AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3560
Mailing Address - Country:US
Mailing Address - Phone:706-331-0598
Mailing Address - Fax:865-622-6937
Practice Address - Street 1:160 COURT AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3560
Practice Address - Country:US
Practice Address - Phone:865-280-2465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC0000002912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health