Provider Demographics
NPI:1629111653
Name:HAMPARIAN, MARY ROSE (PCC SC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ROSE
Last Name:HAMPARIAN
Suffix:
Gender:F
Credentials:PCC SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 FRANTZ RD FL 1
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1559
Mailing Address - Country:US
Mailing Address - Phone:937-738-8333
Mailing Address - Fax:
Practice Address - Street 1:5626 FRANTZ RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1559
Practice Address - Country:US
Practice Address - Phone:937-738-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0008061101YM0800X
OHE0008061101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health