Provider Demographics
NPI:1427239086
Name:GORYL, JOSEPH MARTIN (MA, LPC, LMSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MARTIN
Last Name:GORYL
Suffix:
Gender:M
Credentials:MA, LPC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E SANILAC RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1184
Mailing Address - Country:US
Mailing Address - Phone:810-648-4303
Mailing Address - Fax:810-648-2988
Practice Address - Street 1:119 E SANILAC RD
Practice Address - Street 2:SUITE #3
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1184
Practice Address - Country:US
Practice Address - Phone:810-648-4303
Practice Address - Fax:810-648-2988
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004005101YP2500X
MI68010164341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional