Healthcare Provider Details

I. General information

NPI: 1144628751
Provider Name (Legal Business Name): JENNIFER GIESEL PHD, LICDC-CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 STATE ROUTE 306 #100
WILLOUGHBY OH
44094-9258
US

IV. Provider business mailing address

25101 CHAGRIN BLVD #100
BEACHWOOD OH
44122-5643
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-6611
  • Fax: 216-456-8128
Mailing address:
  • Phone: 216-831-6611
  • Fax: 216-456-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberP.07917
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.07917
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: