MEDICARE: EARLY CHILDHOOD COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144789611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY CHILDHOOD COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	3208 ROBINA LN
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-8679
Country	:	US
Telephone Number	:	513-757-9433
Fax Number	:	513-824-8129

Provider Business Practice Location Address
First Line	:	4947 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3908
Country	:	US
Telephone Number	:	513-757-9433
Fax Number	:	513-824-8129

Authorized Official
Title or Position	:	OWNER
Name	:	LISA M BERNATH
Credential	:	M.ED., LPCC-S
Telephone Number	:	513-295-6182

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	07/11/2022

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