=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427455120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ORION MONROE LPCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2014
-----------------------------------------------------
Last Update Date | 11/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10534 SUCCESS LN MEN'S MENTAL HEALTH INITIATIVE, SUITE E
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45458-3655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-532-6244
-----------------------------------------------------
Fax | 937-919-5509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10534 SUCCESS LN MEN'S MENTAL HEALTH INITIATIVE, SUITE E
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45458-3655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-532-6244
-----------------------------------------------------
Fax | 937-919-5509
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E 1300796
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 160697
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------