Basic Information
Provider Information | |||||||||
NPI: | 1861769978 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NASH | ||||||||
FirstName: | ANN | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 817 | ||||||||
Address2: |   | ||||||||
City: | WEST LIBERTY | ||||||||
State: | OH | ||||||||
PostalCode: | 433570817 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9374658065 | ||||||||
FaxNumber: | 9374650442 | ||||||||
Practice Location | |||||||||
Address1: | 118 MAPLE AVE. | ||||||||
Address2: |   | ||||||||
City: | BELLEFONTAINE | ||||||||
State: | OH | ||||||||
PostalCode: | 43311 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9375991975 | ||||||||
FaxNumber: | 9375992769 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/18/2011 | ||||||||
LastUpdateDate: | 11/18/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C.0900478 |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.