Provider Demographics
NPI:1295367738
Name:MUCCI, ANTHONY (LMHC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MUCCI
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44068-0348
Mailing Address - Country:US
Mailing Address - Phone:440-813-4602
Mailing Address - Fax:
Practice Address - Street 1:179 BROAD ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2614
Practice Address - Country:US
Practice Address - Phone:440-487-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA006143224Z00000X
WALH61510024101YM0800X
OHC.2103535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional