Basic Information
| Provider Information | |||||||||
| NPI: | 1740394410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARBER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LICDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 765 | ||||||||
| Address2: | |||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195622000 | ||||||||
| FaxNumber: | 4195621296 | ||||||||
| Practice Location | |||||||||
| Address1: | 2458 STETZER RD | ||||||||
| Address2: | |||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195622000 | ||||||||
| FaxNumber: | 4195621296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 12/16/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/17/2007 | ||||||||
| NPIReactivationDate: | 12/16/2009 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 933750 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.