MEDICARE: MICHAEL HALL MCGRADY LISW, LICDC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	081199	OH
2	1041C0700X	Clinical Social Worker	I. 1303280	OH

General Provider Information

NPI Number	:	1073882478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HALL MCGRADY LISW, LICDC

Provider Business Mailing Address
First Line	:	471 STATE ROUTE 100
Second Line	:
City	:	BUCYRUS
State	:	OH
Zip	:	44820-9543
Country	:	US
Telephone Number	:	419-985-5293
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 MEADOW DR
Second Line	:	SUITE A
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1389
Country	:	US
Telephone Number	:	419-947-4560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	09/26/2013

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