Provider Demographics
NPI:1346229648
Name:GOEBEL-KOMALA, MARY BETH (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:GOEBEL-KOMALA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3544
Mailing Address - Country:US
Mailing Address - Phone:419-424-3292
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3544
Practice Address - Country:US
Practice Address - Phone:419-423-3292
Practice Address - Fax:419-423-7662
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2502714Medicaid
OH9266572Medicare PIN
OH2502714Medicaid