Provider Demographics
NPI:1144628751
Name:GIESEL, JENNIFER (PHD, LICDC-CS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GIESEL
Suffix:
Gender:F
Credentials:PHD, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25101 CHAGRIN BLVD
Mailing Address - Street 2:#100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5643
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:216-456-8128
Practice Address - Street 1:4212 STATE ROUTE 306
Practice Address - Street 2:#100
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9258
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:216-456-8128
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07917103TA0400X, 103T00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)