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1070 Commerce Dr Bldg 1, Ste 101 Perrysburg OH 43551-5231 | |
| (419) 482-8382 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1070 Commerce Dr, Perrysburg, Ohio |
| Authorized Official Name and Position | Derek J Lee (CEO) |
| Authorized Official Contact | 4192904722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1070 Commerce Drive Building One, Suite 101 Perrysburg OH 43551-5231 Ph: (419) 482-8382 | 1070 Commerce Dr Bldg 1, Ste 101 Perrysburg OH 43551-5231 Ph: (419) 482-8382 |
| NPI Number | 1336822824 |
|---|---|
| Provider Enumeration Date | 08/10/2023 |
| Last Update Date | 08/13/2024 |
| Certification Date | 08/13/2024 |
| Medicare PECOS PAC ID | 0941748313 |
|---|---|
| Medicare Enrollment ID | O20240815004490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336822824 | NPI | - | NPPES |
| Provider Name | Derek Joshua Lee |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356636070 PECOS PAC ID: 1850839226 Enrollment ID: I20240815004525 |
| Provider Name | Benjamin Taylor Finlayson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1053063941 PECOS PAC ID: 7719427434 Enrollment ID: I20240909004413 |
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