Basic Information
| Provider Information | |||||||||
| NPI: | 1548717440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STIRIZ | ||||||||
| FirstName: | DOUG | ||||||||
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| Credential: | CDCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ALVORDTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435019763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199242029 | ||||||||
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| Practice Location | |||||||||
| Address1: | 109 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ALVORDTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435019763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199242029 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2016 | ||||||||
| LastUpdateDate: | 09/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CDCA.141720 | Y | Behavioral Health & Social Service Providers | Counselor | 251S00000X | N | Agencies | Community/Behavioral Health |
No ID Information.