Healthcare Provider Details

I. General information

NPI: 1053384131
Provider Name (Legal Business Name): MARSHALL J PIERSON III LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N DETROIT ST
WEST LIBERTY OH
43357-0817
US

IV. Provider business mailing address

PO BOX 817
WEST LIBERTY OH
43357-0817
US

V. Phone/Fax

Practice location:
  • Phone: 937-465-8065
  • Fax: 937-465-3505
Mailing address:
  • Phone: 937-465-8065
  • Fax: 937-465-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0007302
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: