Provider Demographics
NPI:1669407318
Name:URBANAS, CARLA R (MS,LPCC,LICDC)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:R
Last Name:URBANAS
Suffix:
Gender:F
Credentials:MS,LPCC,LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 JAMES BOHANAN DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2300
Mailing Address - Country:US
Mailing Address - Phone:937-742-7516
Mailing Address - Fax:937-415-0152
Practice Address - Street 1:300 JAMES BOHANAN DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377
Practice Address - Country:US
Practice Address - Phone:937-742-7516
Practice Address - Fax:937-415-0152
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3194101YM0800X
OH991606101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0286795Medicaid
OH0174629Medicaid
OH0284082Medicaid
OH0284072Medicaid
OH0167698Medicaid
OH0215462Medicaid
OH0284102Medicaid
OH0285498Medicaid
OH0285456Medicaid