Active NPI
Lisa Mary Declark
- Mental Health Counselor
- Perrysburg, OH
National Provider Identifier
1134470545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- E.1100125
- Practice address
- 119 W 2ND St
Perrysburg, OH 43551-1402 - Phone
- (419) 376-6059
- NPI assigned
- Sep 25, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | E.1100125 | OH | Primary |
Addresses
Primary practice location
119 W 2ND St
Perrysburg, OH 43551-1402
Mailing address
119 W 2ND St
Perrysburg, OH 43551-1402
Phone (419) 376-6059
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.1100125 | OH | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467936000000",
"number": "1134470545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 W 2ND ST",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "435511402",
"telephone_number": "419-376-6059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 W 2ND ST",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "435511402",
"telephone_number": "419-376-6059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECLARK",
"first_name": "LISA",
"middle_name": "MARY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-25",
"last_updated": "2016-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "E.1100125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Perrysburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.