Provider Demographics
NPI:1891834370
Name:GOSSETT, ELVIA (SW)
Entity type:Individual
Prefix:
First Name:ELVIA
Middle Name:
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-6303
Mailing Address - Country:US
Mailing Address - Phone:423-351-1067
Mailing Address - Fax:
Practice Address - Street 1:600 RAYDER AVE
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1050
Practice Address - Country:US
Practice Address - Phone:865-458-2662
Practice Address - Fax:865-458-8587
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical