| NPI | 1003388620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY JOY CLOSS Office Manager 419-841-2298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2018-12-20 |