Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 172031 | OH |
NPI | 1386289858 |
---|---|
Provider Name | Courtney Gossel |
First Address | Lancaster, OH 43130-2718 |
Second Address | Columbus, OH 43215-1025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2019 |
Last Update Date | 08/11/2019 |