Basic Information
Provider Information
NPI: 1003154410
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILBERT
FirstName: LARYSA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.S., LPCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 277 QUAIL HAVEN DR
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432355652
CountryCode: US
TelephoneNumber: 6143090677
FaxNumber:  
Practice Location
Address1: 299 CRAMER CREEK CT
Address2:  
City: DUBLIN
State: OH
PostalCode: 430172586
CountryCode: US
TelephoneNumber: 6148895722
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/18/2013
LastUpdateDate: 02/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000XC.1200655-TRNEOHN Behavioral Health & Social Service ProvidersCounselor 
101YP2500XE.1901044OHY Behavioral Health & Social Service ProvidersCounselorProfessional
101YP2500XC.1200655OHN Behavioral Health & Social Service ProvidersCounselorProfessional

ID Information
IDTypeStateIssuerDescription
100315441005OH MEDICAID


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