Healthcare Provider Details

I. General information

NPI: 1548273535
Provider Name (Legal Business Name): MARY ANN ECHOLS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 BELMONT AVE
YOUNGSTOWN OH
44505-2401
US

IV. Provider business mailing address

346 TOD LN
YOUNGSTOWN OH
44504-1446
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax: 330-740-9231
Mailing address:
  • Phone: 330-747-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5726
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: