Provider Demographics
NPI:1417275082
Name:JAGOW, MARYE F (LPCC, CDCA)
Entity Type:Individual
Prefix:
First Name:MARYE
Middle Name:F
Last Name:JAGOW
Suffix:
Gender:F
Credentials:LPCC, CDCA
Other - Prefix:
Other - First Name:MARYE
Other - Middle Name:F
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, CDCA
Mailing Address - Street 1:6530 SECOR RD., STE 10
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144
Mailing Address - Country:US
Mailing Address - Phone:734-854-7061
Mailing Address - Fax:530-654-7061
Practice Address - Street 1:4334 WEST CENTRAL AVE., STE 211
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615
Practice Address - Country:US
Practice Address - Phone:734-854-7061
Practice Address - Fax:530-654-7061
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008284101YA0400X
OHE.0008284101YP2500X
OH101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)