Basic Information
| Provider Information | |||||||||
| NPI: | 1821211012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUNSALAN | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | L.P.C.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8970 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436230970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194754449 | ||||||||
| FaxNumber: | 4195171399 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436092701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196715550 | ||||||||
| FaxNumber: | 4197255018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 01/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E 0004246 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.