Provider Demographics
NPI:1114769346
Name:MOLEBASH, WESLEY
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:MOLEBASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E ING ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45644-9572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 E ING ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OH
Practice Address - Zip Code:45644-9572
Practice Address - Country:US
Practice Address - Phone:740-253-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)