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NPI Code Detail

MEDICARE: MR. DAVID GORRELL

MEDICARE: MR. DAVID GORRELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorE0000957OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000375381OTHEROHANTHEM

General Provider Information

NPI Number : 1285625145
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID GORRELL
Provider Business Mailing Address
First Line : 210 N MAIN ST
Second Line :
City : LONDON
State : OH
Zip : 43140-1115
Country : US
Telephone Number : 740-852-6256
Fax Number : 740-852-6395
Provider Business Practice Location Address
First Line : 210 N MAIN ST
Second Line :
City : LONDON
State : OH
Zip : 43140-1115
Country : US
Telephone Number : 740-852-6256
Fax Number : 740-852-6395
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 07/08/2007

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Directions to “ MR. DAVID GORRELL ” Practice Location

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