Healthcare Provider Details

I. General information

NPI: 1598175093
Provider Name (Legal Business Name): MARCEY BELL LISWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCEY GODFREY

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S MAIN ST
ADA OH
45810-6000
US

IV. Provider business mailing address

658 W MARKET ST SUITE 101
LIMA OH
45801-4653
US

V. Phone/Fax

Practice location:
  • Phone: 419-604-3372
  • Fax:
Mailing address:
  • Phone: 419-221-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1600006-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1303130
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: