Provider Demographics
NPI:1881040517
Name:TIRCUIT, GIZELLE (LPC)
Entity Type:Individual
Prefix:
First Name:GIZELLE
Middle Name:
Last Name:TIRCUIT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST STE 309
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6112
Mailing Address - Country:US
Mailing Address - Phone:860-439-1300
Mailing Address - Fax:860-439-1300
Practice Address - Street 1:300 STATE ST STE 309
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6112
Practice Address - Country:US
Practice Address - Phone:860-439-1300
Practice Address - Fax:860-439-1300
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CT002923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional