Provider Demographics
NPI:1407066079
Name:UNDERFER-BABALIS, JEAN (MED, PCC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:UNDERFER-BABALIS
Suffix:
Gender:F
Credentials:MED, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MONROE ST.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3469
Mailing Address - Country:US
Mailing Address - Phone:419-842-0140
Mailing Address - Fax:419-842-0142
Practice Address - Street 1:5151 MONROE ST.
Practice Address - Street 2:SUITE 250
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3469
Practice Address - Country:US
Practice Address - Phone:419-842-0140
Practice Address - Fax:419-842-0142
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0002748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional