Lisa Mary Declark
Counselor, Mental Health in Perrysburg, OH. Individual provider (NPI-1).
NPI number1134470545
StatusActive
Last updated in NPPESJul 8, 2016
Details
- NPI
- 1134470545
- Entity type
- Individual (NPI-1)
- Name
- Lisa Mary Declark
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 25, 2012
- Last updated
- Jul 8, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | E.1100125 | OH | Yes |
Practice location
119 W 2nd StPerrysburg, OH 43551-1402
Phone 419-376-6059
Mailing address
119 W 2nd StPerrysburg, OH 43551-1402
Phone 419-376-6059
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