=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508573064
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA PARSONS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2022
-----------------------------------------------------
Last Update Date | 11/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2775 STATE ROUTE 39
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44875-9466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-747-3322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 338 SOUTH ST
-----------------------------------------------------
City | GALION
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44833-2705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-231-3299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CDCA.182379
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------