Basic Information
Provider Information | |||||||||
NPI: | 1295849958 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MASH | ||||||||
FirstName: | DARLA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPCC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MASH | ||||||||
OtherFirstName: | DARLA | ||||||||
OtherMiddleName: | HAZEN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LPCC | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 765 | ||||||||
Address2: |   | ||||||||
City: | BUCYRUS | ||||||||
State: | OH | ||||||||
PostalCode: | 448200765 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4195622000 | ||||||||
FaxNumber: | 4195621296 | ||||||||
Practice Location | |||||||||
Address1: | 2458 STETZER RD | ||||||||
Address2: |   | ||||||||
City: | BUCYRUS | ||||||||
State: | OH | ||||||||
PostalCode: | 448202066 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4195622000 | ||||||||
FaxNumber: | 4195621296 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/19/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E0003556 | OH | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.