Healthcare Provider Details

I. General information

NPI: 1811805633
Provider Name (Legal Business Name): KELSEY GORCHEFF LSP
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: VIC GORCHEFF

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GLAMORGAN ST
ALLIANCE OH
44601-2810
US

IV. Provider business mailing address

400 GLAMORGAN ST
ALLIANCE OH
44601-2810
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-2100
  • Fax:
Mailing address:
  • Phone: 330-821-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.03335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: