Healthcare Provider Details

I. General information

NPI: 1922641372
Provider Name (Legal Business Name): MARY ANN ECHOLS,PHD,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 TIBBETTS WICK RD
GIRARD OH
44420-1231
US

IV. Provider business mailing address

2302 TIBBETTS WICK RD
GIRARD OH
44420-1231
US

V. Phone/Fax

Practice location:
  • Phone: 330-610-3879
  • Fax:
Mailing address:
  • Phone: 330-610-3879
  • Fax: 330-747-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY ANN ECHOLS
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 330-610-3879