1487646865 NPI number — PAULDING COUNSELING CENTER

Table of content: MR. EDWARD LOUIS PACETTI JR. LCSW (NPI 1992739502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487646865 NPI number — PAULDING COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAULDING COUNSELING CENTER
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:
6
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:
1487646865
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 329
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAULDING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45879-0329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-399-3636
Provider Business Mailing Address Fax Number:
419-399-5915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 MCDONALD PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAULDING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-399-3636
Provider Business Practice Location Address Fax Number:
419-399-5915
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOYINGS
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
419-399-3636

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0046 , 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: MC-48-03-00 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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