Healthcare Provider Details

I. General information

NPI: 1992313340
Provider Name (Legal Business Name): SHIVAM KAMLESH GOSAI PH.D., LPC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ROCK RUN RD
MC MURRAY PA
15317-6624
US

IV. Provider business mailing address

101 ROCK RUN RD
MC MURRAY PA
15317-6624
US

V. Phone/Fax

Practice location:
  • Phone: 724-825-0210
  • Fax:
Mailing address:
  • Phone: 724-825-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC015991
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: