Provider Demographics
NPI:1215296355
Name:DELZEITH, MOLLIE D (PC)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:D
Last Name:DELZEITH
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:D
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2150 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3834
Mailing Address - Country:US
Mailing Address - Phone:419-291-8438
Mailing Address - Fax:419-291-6468
Practice Address - Street 1:2150 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3834
Practice Address - Country:US
Practice Address - Phone:419-291-8438
Practice Address - Fax:419-291-6468
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional