Healthcare Provider Details

I. General information

NPI: 1790012995
Provider Name (Legal Business Name): GAHANNA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 GRANVILLE ST STE C
COLUMBUS OH
43230-2967
US

IV. Provider business mailing address

181 GRANVILLE ST STE C
COLUMBUS OH
43230-2967
US

V. Phone/Fax

Practice location:
  • Phone: 614-342-0243
  • Fax:
Mailing address:
  • Phone: 614-342-0243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE-0500159
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-030656
License Number StateOH

VIII. Authorized Official

Name: MATTHEW PETER ORLOUSKY
Title or Position: MEMBER-MANAGER
Credential: LPCC-S
Phone: 614-266-8278