Healthcare Provider Details

I. General information

NPI: 1922070895
Provider Name (Legal Business Name): PATRICIA D DEINLEIN LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N MAIN
MARYSVILLE OH
43040
US

IV. Provider business mailing address

4624 SAWMILL RD
COLUMBUS OH
43220-2247
US

V. Phone/Fax

Practice location:
  • Phone: 937-642-1254
  • Fax: 937-642-2806
Mailing address:
  • Phone: 614-459-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE0003433
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0003433-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: