Provider Demographics
NPI:1124440433
Name:RIAZZI, MARY BETH (LPCC-S, LICDC)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:RIAZZI
Suffix:
Gender:F
Credentials:LPCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EASTON OVAL STE 115
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6036
Mailing Address - Country:US
Mailing Address - Phone:614-934-6890
Mailing Address - Fax:614-934-6888
Practice Address - Street 1:2 EASTON OVAL STE 115
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6036
Practice Address - Country:US
Practice Address - Phone:614-934-6890
Practice Address - Fax:614-934-6888
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1100228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101Y00000XOtherCOUNSELOR