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General NPI Number Information
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NPI Number | 1629233655
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Entity Type | Individual
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Provider Name | ELIZABETH E. STAAS LSW CDCA
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Gender | Female
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 131 N. MAIN ST.
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City | MARYSVILLE
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State | OH
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Zip | 43040
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Country | US
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Telephone | 937-642-1254
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Fax | 937-642-2806
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Provider Business Mailing Address
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Address Line | PO BOX 817 1521 N. DETROIT ST.
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City | WEST LIBERTY
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State | OH
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Zip | 43357-0817
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Country | US
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Telephone | 937-465-8065
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Fax | 937-465-0442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1000277
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 101076
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License Number State | OH
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