Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | C1300446 | OH |
NPI | 1003267477 |
---|---|
Provider Name | Jaime Surber |
First Address | Delphos, OH 45833-9058 |
Second Address | Cincinnati, OH 45246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2016 |
Last Update Date | 11/04/2019 |