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General NPI Number Information
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NPI Number | 1962848804
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Entity Type | Individual
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Provider Name | MARI LYN LPCC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 1711 SPRING AVE NE
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City | CANTON
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State | OH
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Zip | 44714-2349
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Country | US
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Telephone | 330-454-6800
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Fax | 330-588-7176
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Provider Business Mailing Address
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Address Line | 625 CLEVELAND AVE NW
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City | CANTON
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State | OH
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Zip | 44702-1805
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Country | US
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Telephone | 330-455-0374
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Fax | 330-455-2101
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.1300345
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License Number State | OH
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