Healthcare Provider Details

I. General information

NPI: 1760995880
Provider Name (Legal Business Name): CRAIG A BILLS LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 11/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VAN GUNDY DR
BRYAN OH
43506-1153
US

IV. Provider business mailing address

200 VAN GUNDY DR
BRYAN OH
43506-1153
US

V. Phone/Fax

Practice location:
  • Phone: 419-636-0410
  • Fax: 419-636-6510
Mailing address:
  • Phone: 419-636-0410
  • Fax: 419-636-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS1450519
License Number StateOH

VII. Legacy identifiers

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

# 1
IdentifierS1450519
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: