Basic Information
Provider Information | |||||||||
NPI: | 1639253271 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ILIFF | ||||||||
FirstName: | DON | ||||||||
MiddleName: | E. | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | LISW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3224 JURNEE DR | ||||||||
Address2: |   | ||||||||
City: | FINDLAY | ||||||||
State: | OH | ||||||||
PostalCode: | 458407922 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5675254169 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1918 N MAIN ST | ||||||||
Address2: |   | ||||||||
City: | FINDLAY | ||||||||
State: | OH | ||||||||
PostalCode: | 458403818 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4194255050 | ||||||||
FaxNumber: | 4194236464 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/24/2006 | ||||||||
LastUpdateDate: | 10/15/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 071035 | OH | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 0718000152 | VA | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 0904003944 | VA | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | I0700242 | OH | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | 187848 | 01 | VA | ANTHEM | OTHER | 089206 | 01 | VA | OPTIMA | OTHER |