Healthcare Provider Details

I. General information

NPI: 1972010205
Provider Name (Legal Business Name): ALYSSA MARUK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA GRAHL

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 22ND ST
TOLEDO OH
43604-2706
US

IV. Provider business mailing address

3909 WOODLEY RD
TOLEDO OH
43606-1169
US

V. Phone/Fax

Practice location:
  • Phone: 419-241-6191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001608-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPP-000112045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: