MEDICARE: MR. MARK LEVERNE SIMPSON 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	976170	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	976170	OTHER	OH	INDEPENDENT CHEMICAL DEPENDENCY COUNSELOR

General Provider Information

NPI Number	:	1174878987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK LEVERNE SIMPSON LICDC

Provider Business Mailing Address
First Line	:	1410 CLEVELAND AVE
Second Line	:	SUITE 2
City	:	COLUMBUS
State	:	OH
Zip	:	43211-2760
Country	:	US
Telephone Number	:	614-294-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 CLEVELAND AVE
Second Line	:	SUITE 2
City	:	COLUMBUS
State	:	OH
Zip	:	43211-2760
Country	:	US
Telephone Number	:	614-294-5677
Fax Number	:

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

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	07/17/2012

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