Basic Information
| Provider Information | |||||||||
| NPI: | 1326427972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOBSER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MA LPCC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 W ALEXIS RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436132303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192666060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 JEFFERSON AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436046956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192559585 | ||||||||
| FaxNumber: | 4192558855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2015 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | E.0700017 | OH | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 0214630 | 05 | OH | MEDICAID |