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NPI Code Detail

MEDICARE: JESSE NMN PHIFER III ACSW, LISW

MEDICARE: JESSE NMN PHIFER III ACSW, LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorI-0003193OH

General Provider Information

NPI Number : 1780766550
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE NMN PHIFER III ACSW, LISW
Provider Business Mailing Address
First Line : 1323 UPTON AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43607-1766
Country : US
Telephone Number : 419-259-2000
Fax Number : 419-259-3850
Provider Business Practice Location Address
First Line : 3333 GLENDALE AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43614-2426
Country : US
Telephone Number : 419-259-2000
Fax Number : 419-259-3850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 06/28/2026

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