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General NPI Number Information
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NPI Number | 1265891402
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Entity Type | Organization
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Legal Business Name | TRINITY CARE OF OHIO, LLC
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 122 W FRONT ST SUITE D
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City | PERRYSBURG
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State | OH
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Zip | 43551-1467
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Country | US
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Telephone | 702-810-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 122 W FRONT ST SUITE D
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City | PERRYSBURG
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State | OH
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Zip | 43551-1467
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Country | US
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Telephone | 702-810-5940
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | NANNETTE FADER
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Credential | IMFT
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Telephone | 702-810-5940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | F15000022
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License Number State | OH
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