Provider Demographics
NPI:1427794460
Name:GOSSARD, MICHELLE (LMHC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GOSSARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-4100
Mailing Address - Country:US
Mailing Address - Phone:515-954-0389
Mailing Address - Fax:
Practice Address - Street 1:214 7TH ST NE
Practice Address - Street 2:
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-4100
Practice Address - Country:US
Practice Address - Phone:515-954-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001182101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty