| Square North Practice | |
|
126 N Main St Bryan OH 43506-1316 | |
| (419) 630-5430 | |
| (419) 754-2215 |
| Full Name | Square North Practice |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 126 N Main St, Bryan, Ohio |
| Authorized Official Name and Position | Judith Ann Guess (CLINICAL PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 4196305430 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Square North Practice 126 N Main St Bryan OH 43506-1316 Ph: (419) 630-5430 | Square North Practice 126 N Main St Bryan OH 43506-1316 Ph: (419) 630-5430 |
| NPI Number | 1720583776 |
|---|---|
| Provider Enumeration Date | 03/29/2018 |
| Last Update Date | 02/16/2021 |
| Certification Date | 02/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720583776 | NPI | - | NPPES |
| 0065271 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6910 (Ohio) | Primary |
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