Provider Demographics
NPI:1134200199
Name:SEABURN, JOYCE ANN (LISW)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:ANN
Last Name:SEABURN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:JODI
Other - Middle Name:ANN
Other - Last Name:SEABURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:231 W MARION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1417
Mailing Address - Country:US
Mailing Address - Phone:419-946-9596
Mailing Address - Fax:
Practice Address - Street 1:950 MEADOW DR
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1055
Practice Address - Country:US
Practice Address - Phone:419-947-4560
Practice Address - Fax:419-947-2956
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000072961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical