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General NPI Number Information
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NPI Number | 1790012995
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Entity Type | Organization
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Legal Business Name | GAHANNA COUNSELING, LLC
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 181 GRANVILLE ST STE C
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City | COLUMBUS
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State | OH
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Zip | 43230-2967
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Country | US
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Telephone | 614-342-0243
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Fax |
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Provider Business Mailing Address
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Address Line | 181 GRANVILLE ST STE C
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City | COLUMBUS
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State | OH
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Zip | 43230-2967
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Country | US
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Telephone | 614-342-0243
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Fax |
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Authorized Official
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Title or Position | MEMBER-MANAGER
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Name | MATTHEW PETER ORLOUSKY
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Credential | LPCC-S
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Telephone | 614-266-8278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-030656
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E-0500159
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License Number State | OH
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