| Doctor Name: | MARY BURGESS TODD |
| NPI Number: | 1063712404 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, PC, CFC |
| License Number: | C-0900022 |
| Business Practice Address: | 777 S Washington St Tiffin, OH - 448833325 |
| Business Phone Number: | 4194484094 |
| Business Fax Number: | 4194484095 |
| Mailing Address: | 34 Glenview Terrace, TIFFIN |
| State: | OH |
| Postal Code: | 44883 |
| Phone Number: | 4199340330 |
| Fax Number: | 4194484095 |
| NPI Enumeration Date: | 11/02/2010 |
| NPI Last Update Date: | 11/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | C-0900022 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |