Provider Demographics
NPI:1265048532
Name:DEANN GOSSARD LLC
Entity type:Organization
Organization Name:DEANN GOSSARD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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, LICDC
Authorized Official - Phone:419-277-5816
Mailing Address - Street 1:2592 WOODVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43619-1444
Mailing Address - Country:US
Mailing Address - Phone:419-315-6422
Mailing Address - Fax:833-381-0977
Practice Address - Street 1:2592 WOODVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1444
Practice Address - Country:US
Practice Address - Phone:419-315-6422
Practice Address - Fax:833-381-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty