Provider Demographics
NPI:1619686359
Name:TEMPLE, MARITA L (LPC)
Entity Type:Individual
Prefix:
First Name:MARITA
Middle Name:L
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 W BANCROFT ST APT 6
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3244
Mailing Address - Country:US
Mailing Address - Phone:419-320-3714
Mailing Address - Fax:
Practice Address - Street 1:1070 COMMERCE DR STE 101
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5231
Practice Address - Country:US
Practice Address - Phone:419-482-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health