1194806000 NPI number — THE OPTI-HEALTH GROUP

Table of content: MRS. SANDY ANN MARSHALL HUMPHREYS LPC LMFT (NPI 1891856696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194806000 NPI number — THE OPTI-HEALTH GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE OPTI-HEALTH GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194806000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FINDLAY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45839-0239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-422-5526
Provider Business Mailing Address Fax Number:
419-422-5562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7640 SYLVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE B1
Provider Business Practice Location Address City Name:
SYLVANIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560-9729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-517-7538
Provider Business Practice Location Address Fax Number:
419-517-7539
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REITER
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
419-422-5526

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  4220730005 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2521720 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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