Provider Demographics
NPI:1740274398
Name:GOSHA, TIONA LYNN I (RN, LPC)
Entity type:Individual
Prefix:MISS
First Name:TIONA
Middle Name:LYNN
Last Name:GOSHA
Suffix:I
Gender:F
Credentials:RN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 AUBURN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4314
Mailing Address - Country:US
Mailing Address - Phone:216-322-4869
Mailing Address - Fax:800-662-9647
Practice Address - Street 1:2000 AUBURN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4314
Practice Address - Country:US
Practice Address - Phone:216-322-4869
Practice Address - Fax:800-662-9647
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184597163W00000X
OHC 0700085101YP2500X
OHC0700085101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2268531Medicaid