Healthcare Provider Details

I. General information

NPI: 1104459098
Provider Name (Legal Business Name): GEMSTONE COUNSELING CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28916 EUCLID AVE
WICKLIFFE OH
44092
US

IV. Provider business mailing address

28916 EUCLID AVE
WICKLIFFE OH
44092
US

V. Phone/Fax

Practice location:
  • Phone: 440-944-6565
  • Fax: 440-944-0489
Mailing address:
  • Phone: 440-944-6565
  • Fax: 440-944-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY MARK ECHT
Title or Position: EXECUTIVE DIRECTOR
Credential: LPCC LMHC LICDC SAP
Phone: 440-944-6565