Provider Demographics
NPI:1972671949
Name:BOAS, MARLENE P (PHD, LPCC)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:P
Last Name:BOAS
Suffix:
Gender:F
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W STONEPLACE DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5481
Mailing Address - Country:US
Mailing Address - Phone:419-624-1277
Mailing Address - Fax:
Practice Address - Street 1:1717 E PERKINS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7919
Practice Address - Country:US
Practice Address - Phone:419-624-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health