Provider Demographics
NPI:1811044274
Name:STROBEL, GLEN FRANCIS (PH D)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:FRANCIS
Last Name:STROBEL
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2730
Mailing Address - Country:US
Mailing Address - Phone:419-227-5515
Mailing Address - Fax:419-227-8827
Practice Address - Street 1:1000 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2730
Practice Address - Country:US
Practice Address - Phone:419-227-5515
Practice Address - Fax:419-227-8827
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH964477101YA0400X
OH3263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0842717Medicaid
OH0842717Medicaid