| Fuse Trauma Recovery | |
|
2592 Woodville Rd Northwood OH 43619-1444 | |
| (419) 315-6422 | |
| (833) 381-0977 |
| Full Name | Fuse Trauma Recovery |
|---|---|
| Speciality | Counselor |
| Location | 2592 Woodville Rd, Northwood, Ohio |
| Authorized Official Name and Position | Deann Gossard (OWNER) |
| Authorized Official Contact | 4192775816 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fuse Trauma Recovery 2592 Woodville Rd Northwood OH 43619-1444 Ph: (419) 315-6422 | Fuse Trauma Recovery 2592 Woodville Rd Northwood OH 43619-1444 Ph: (419) 315-6422 |
| NPI Number | 1265048532 |
|---|---|
| Provider Enumeration Date | 09/21/2020 |
| Last Update Date | 08/02/2024 |
| Certification Date | 08/02/2024 |
| Medicare PECOS PAC ID | 8123433257 |
|---|---|
| Medicare Enrollment ID | O20230206002870 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265048532 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Ashley Nichole Thielman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235607300 PECOS PAC ID: 3779955497 Enrollment ID: I20230207000481 |
| Provider Name | Deann M Gossard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275923658 PECOS PAC ID: 3870908908 Enrollment ID: I20240209000470 |
Fuse Trauma Recovery Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2592 Woodville Rd, Northwood, OH 43619 Phone: 419-277-5816 Fax: 833-381-0977 |