Provider Demographics
NPI:1063700532
Name:KASBERG, MARY K (LPCC-S)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:KASBERG
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9906 LONG RD
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9706
Mailing Address - Country:US
Mailing Address - Phone:614-439-2990
Mailing Address - Fax:614-252-4200
Practice Address - Street 1:3964 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2949
Practice Address - Country:US
Practice Address - Phone:614-252-2500
Practice Address - Fax:614-252-4200
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0501082-S101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional