Healthcare Provider Details

I. General information

NPI: 1699741702
Provider Name (Legal Business Name): GAIL R. HOUK LPCC -S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 NORTHLAND DR SUITE 200A
MEDINA OH
44256-3441
US

IV. Provider business mailing address

1005 LAKESHORE WALK
MEDINA OH
44256-1294
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-9195
  • Fax: 330-725-9187
Mailing address:
  • Phone: 330-391-0586
  • Fax: 330-725-9187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0001582 SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: