Basic Information
| Provider Information | |||||||||
| NPI: | 1467510289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 GALLIA ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403534673 | ||||||||
| FaxNumber: | 7403535800 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 GALLIA ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403534673 | ||||||||
| FaxNumber: | 7403535800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 12/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | E0003127 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 101YP2500X | E3127 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 0200599 | 05 | OH | MEDICAID | 0144728 | 05 | OH | MEDICAID |