Provider Demographics
NPI:1912443391
Name:FRANCIS, AUDRA
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7959 STATE ROUTE 124
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:OH
Mailing Address - Zip Code:45646
Mailing Address - Country:US
Mailing Address - Phone:740-492-2881
Mailing Address - Fax:
Practice Address - Street 1:7959 STATE ROUTE 124
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:OH
Practice Address - Zip Code:45646
Practice Address - Country:US
Practice Address - Phone:740-492-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3233861103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool