Provider Demographics
NPI:1205200250
Name:JUDY L. DAUBENMIRE
Entity Type:Organization
Organization Name:JUDY L. DAUBENMIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCC
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUBENMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-720-6463
Mailing Address - Street 1:545 N BROAD ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9200
Mailing Address - Country:US
Mailing Address - Phone:330-770-6269
Mailing Address - Fax:
Practice Address - Street 1:545 N BROAD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9200
Practice Address - Country:US
Practice Address - Phone:330-770-6269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0003700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty