Basic Information
Provider Information
NPI: 1871955138
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERMILLER
FirstName: AARON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10100 ELIDA RD
Address2:  
City: DELPHOS
State: OH
PostalCode: 458339056
CountryCode: US
TelephoneNumber: 4196958010
FaxNumber: 4196950004
Practice Location
Address1: 658 W MARKET ST STE 101
Address2:  
City: LIMA
State: OH
PostalCode: 458015604
CountryCode: US
TelephoneNumber: 4192221527
FaxNumber: 4192223586
Other Information
ProviderEnumerationDate: 03/25/2016
LastUpdateDate: 12/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/20/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XC1400158OHY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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