Basic Information
| Provider Information | |||||||||
| NPI: | 1376645622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN HOOSER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LOU | ||||||||
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| Credential: | MSW, LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4449 STATE ROUTE 159 | ||||||||
| Address2: | P.O. BOX 6179 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407751260 | ||||||||
| FaxNumber: | 7407731264 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456012639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407751270 | ||||||||
| FaxNumber: | 7407751274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 10/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I-0009592 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | VASW33575 | 01 | OH | HIGHLAND | OTHER | VASW33576 | 01 | OH | FSC | OTHER | VASW33571 | 01 | OH | FAYETTE | OTHER | VASW33574 | 01 | OH | ROSS | OTHER | VASW33572 | 01 | OH | PICKAWAY | OTHER | VASW33573 | 01 | OH | PIKE | OTHER |