Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | C0602194 | OH |
NPI | 1003048257 |
---|---|
Provider Name | John D Leiws |
First Address | Warren, OH 44484-2345 |
Second Address | Warren, OH 44484-2345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 20/08/2009 |