| Mourning Glory Counseling, Llc | |
|
1011 Sandusky St Ste G Perrysburg OH 43551-3171 | |
| (419) 276-0695 | |
| Not Available |
| Full Name | Mourning Glory Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1011 Sandusky St Ste G, Perrysburg, Ohio |
| Authorized Official Name and Position | Paula Rose Tasma (OWNER) |
| Authorized Official Contact | 4192760695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mourning Glory Counseling, Llc 1011 Sandusky St Ste G Perrysburg OH 43551-3171 Ph: (419) 276-0695 | Mourning Glory Counseling, Llc 1011 Sandusky St Ste G Perrysburg OH 43551-3171 Ph: (419) 276-0695 |
| NPI Number | 1154047306 |
|---|---|
| Provider Enumeration Date | 10/18/2022 |
| Last Update Date | 12/23/2022 |
| Certification Date | 12/23/2022 |
| Medicare PECOS PAC ID | 0840712899 |
|---|---|
| Medicare Enrollment ID | O20250319001318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154047306 | NPI | - | NPPES |
| 0341480 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Paul Tasma |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295149573 PECOS PAC ID: 3971027160 Enrollment ID: I20250409002540 |
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