Healthcare Provider Details

I. General information

NPI: 1619008125
Provider Name (Legal Business Name): JULIE R COUNTS LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4761 STATE ROUTE 29
CELINA OH
45822-8216
US

IV. Provider business mailing address

4761 STATE ROUTE 29
CELINA OH
45822-8216
US

V. Phone/Fax

Practice location:
  • Phone: 419-584-1000
  • Fax: 419-584-1825
Mailing address:
  • Phone: 419-584-1000
  • Fax: 419-584-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0031001-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: