Basic Information
Provider Information | |||||||||
NPI: | 1588190532 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GINTER | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LISW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2775 STATE ROUTE 39 | ||||||||
Address2: |   | ||||||||
City: | SHELBY | ||||||||
State: | OH | ||||||||
PostalCode: | 448759466 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4197473322 | ||||||||
FaxNumber: | 4197470354 | ||||||||
Practice Location | |||||||||
Address1: | 2775 STATE ROUTE 39 | ||||||||
Address2: |   | ||||||||
City: | SHELBY | ||||||||
State: | OH | ||||||||
PostalCode: | 448759466 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4197473322 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/11/2017 | ||||||||
LastUpdateDate: | 07/14/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/14/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1502432 | OH | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 101YA0400X | LCDCIII.161961 | OH | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | I.2203547 | OH | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.