Provider Demographics
NPI:1376645622
Name:VAN HOOSER, MARY LOU (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:VAN HOOSER
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 STATE ROUTE 159
Mailing Address - Street 2:P.O. BOX 6179
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8620
Mailing Address - Country:US
Mailing Address - Phone:740-775-1260
Mailing Address - Fax:740-773-1264
Practice Address - Street 1:312 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2639
Practice Address - Country:US
Practice Address - Phone:740-775-1270
Practice Address - Fax:740-775-1274
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00095921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVASW33575OtherHIGHLAND
OHVASW33576OtherFSC
OHVASW33571OtherFAYETTE
OHVASW33574OtherROSS
OHVASW33572OtherPICKAWAY
OHVASW33573OtherPIKE