MEDICARE: MARGIE W MORTIMER M.A., L.P.C.C.

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	101YP2500X	Professional Counselor	E2013	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140050555854	OTHER		HUMANA
2	2003888	OTHER		CIGNA BEHAVIORAL HEALTH
3	NL724	OTHER	NY	EMPIREBLUECROSSBLUESHIELD
4	22000000222923	OTHER		ANTHEM
5	5206754	OTHER		AETNA
6	1-9H5565	OTHER		HORIZON HEALTH
7	22000000222920	OTHER		ANTHEM

General Provider Information

NPI Number	:	1174613467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGIE W MORTIMER M.A., L.P.C.C.

Provider Business Mailing Address
First Line	:	2874 VICTORIA AVE
Second Line	:	SUITE B
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1431
Country	:	US
Telephone Number	:	513-321-7702
Fax Number	:	513-321-4703

Provider Business Practice Location Address
First Line	:	10979 REED HARTMAN HWY
Second Line	:	SUITE 125
City	:	CINCINNATI
State	:	OH
Zip	:	45242-2800
Country	:	US
Telephone Number	:	513-321-7702
Fax Number	:	513-321-4703

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

Provider Enumeration Date	:	10/15/2006
Last Update Date	:	07/08/2007

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