Provider Demographics
NPI:1639341589
Name:MAUMEE VALLEY GUIDANCE CENTER
Entity Type:Organization
Organization Name:MAUMEE VALLEY GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-782-8856
Mailing Address - Street 1:211 BIEDE AVE
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2408
Mailing Address - Country:US
Mailing Address - Phone:419-782-8856
Mailing Address - Fax:419-782-2261
Practice Address - Street 1:211 BIEDE AVE
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2408
Practice Address - Country:US
Practice Address - Phone:419-782-8856
Practice Address - Fax:419-782-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0304807Medicaid