Basic Information
| Provider Information | |||||||||
| NPI: | 1417072646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TURSIC | ||||||||
| FirstName: | GAYLE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC, IMFT, LSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HITCHCOCK | ||||||||
| OtherFirstName: | GAYLE | ||||||||
| OtherMiddleName: | S. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPCC, IMFT, LSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4334 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194754449 | ||||||||
| FaxNumber: | 4194793230 | ||||||||
| Practice Location | |||||||||
| Address1: | 4334 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194754449 | ||||||||
| FaxNumber: | 4194793230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E0002346 | OH | X | Behavioral Health & Social Service Providers | Counselor | Professional | 104100000X | S0016831 | OH | X | Behavioral Health & Social Service Providers | Social Worker | 106H00000X | F0500013 | OH | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.