Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | E.1901202 | OH |
NPI | 1003356700 |
---|---|
Provider Name | Shana Bentley |
First Address | Toledo, OH 43604-5027 |
Second Address | Toledo, OH 43604-5027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2017 |
Last Update Date | 20/06/2019 |