Provider Demographics
NPI:1760811848
Name:MAUMEE VALLEY GUIDANCE CENTER
Entity Type:Organization
Organization Name:MAUMEE VALLEY GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANSON
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
Mailing Address - Country:US
Mailing Address - Phone:419-782-8856
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200884Medicaid
OHMA9163721Medicare UPIN