Provider Demographics
NPI:1952570871
Name:GEDOSH, LORETTA J (LPC)
Entity type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:J
Last Name:GEDOSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:110 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3362
Mailing Address - Country:US
Mailing Address - Phone:479-967-5570
Mailing Address - Fax:479-890-5364
Practice Address - Street 1:1021 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4428
Practice Address - Country:US
Practice Address - Phone:479-754-8610
Practice Address - Fax:479-754-8788
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health