Healthcare Provider Details

I. General information

NPI: 1811044274
Provider Name (Legal Business Name): GLEN FRANCIS STROBEL PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W MARKET ST
LIMA OH
45805-2730
US

IV. Provider business mailing address

1000 W MARKET ST
LIMA OH
45805-2730
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-5515
  • Fax: 419-227-8827
Mailing address:
  • Phone: 419-227-5515
  • Fax: 419-227-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number964477
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3263
License Number StateOH

VII. Legacy identifiers

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

# 1
Identifier0842717
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: