Healthcare Provider Details

I. General information

NPI: 1740274398
Provider Name (Legal Business Name): TIONA LYNN GOSHA I RN, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 AUBURN DR SUITE 200
BEACHWOOD OH
44122-4314
US

IV. Provider business mailing address

2000 AUBURN DR SUITE 200
BEACHWOOD OH
44122-4314
US

V. Phone/Fax

Practice location:
  • Phone: 216-322-4869
  • Fax: 800-662-9647
Mailing address:
  • Phone: 216-322-4869
  • Fax: 800-662-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberC0700085
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC 0700085
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number184597
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: