Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 3659 | OH |
NPI | 1003031048 |
---|---|
Provider Name | Richard Mague |
First Address | Worthington, OH 43085-2362 |
Second Address | Worthington, OH 43085-2362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |