Basic Information
| Provider Information | |||||||||
| NPI: | 1346776283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOTSCHALL | ||||||||
| FirstName: | COURTNEY | ||||||||
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| Credential: | PSYCHOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 434 EASTLAND RD | ||||||||
| Address2: | |||||||||
| City: | BEREA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440171217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402608327 | ||||||||
| FaxNumber: | 4402348319 | ||||||||
| Practice Location | |||||||||
| Address1: | 16101 SNOW RD | ||||||||
| Address2: | STE. 103 | ||||||||
| City: | BROOKPARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441422817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402606860 | ||||||||
| FaxNumber: | 2168982876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 7068 | OH | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.