Healthcare Provider Details

I. General information

NPI: 1497457261
Provider Name (Legal Business Name): PHILLIP TEMPLE CDCA, OCPRS, QMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 N MAIN ST
MARION OH
43302-1736
US

IV. Provider business mailing address

827 N MAIN ST
MARION OH
43302-1736
US

V. Phone/Fax

Practice location:
  • Phone: 740-914-5000
  • Fax: 740-914-5005
Mailing address:
  • Phone: 740-914-5000
  • Fax: 740-914-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.191435
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: