Provider Demographics
NPI:1285720920
Name:GILL, MYRNA ROTHCHILD (LPCC OH E0000094)
Entity type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:ROTHCHILD
Last Name:GILL
Suffix:
Gender:F
Credentials:LPCC OH E0000094
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23360 CHAGRIN BOULEVARD
Mailing Address - Street 2:102
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5537
Mailing Address - Country:US
Mailing Address - Phone:216-591-1456
Mailing Address - Fax:216-464-3131
Practice Address - Street 1:23360 CHAGRIN BOULEVARD
Practice Address - Street 2:102
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5537
Practice Address - Country:US
Practice Address - Phone:216-591-1456
Practice Address - Fax:216-464-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPCC E0000094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional