Healthcare Provider Details

I. General information

NPI: 1669407318
Provider Name (Legal Business Name): CARLA R URBANAS MS,LPCC,LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 JAMES BOHANAN DR
VANDALIA OH
45377
US

IV. Provider business mailing address

300 JAMES BOHANAN DR
VANDALIA OH
45377-2300
US

V. Phone/Fax

Practice location:
  • Phone: 937-742-7516
  • Fax: 937-415-0152
Mailing address:
  • Phone: 937-742-7516
  • Fax: 937-415-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE3194
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number991606
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: