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NPI Code Detail

MEDICARE: MS. MARY K. KASBERG LPCC-S

MEDICARE: MS. MARY K. KASBERG LPCC-S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorE0501082-SOH

General Provider Information

NPI Number : 1063700532
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY K. KASBERG LPCC-S
Provider Business Mailing Address
First Line : 9906 LONG RD
Second Line :
City : CANAL WINCHESTER
State : OH
Zip : 43110-9706
Country : US
Telephone Number : 614-439-2990
Fax Number : 614-252-4200
Provider Business Practice Location Address
First Line : 3964 E MAIN ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-2949
Country : US
Telephone Number : 614-252-2500
Fax Number : 614-252-4200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2011
Last Update Date : 03/17/2018

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