MEDICARE: UNIVERSITY OF CINCINNATI COUNSELING & PSYCHOLOGICAL SERVICES

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	103TC1900X	Counseling Psychologist
2	103TS0200X	School Psychologist	6911	OH

General Provider Information

NPI Number	:	1558425363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF CINCINNATI COUNSELING & PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	MAIL LOCATION 0034
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45221-0034
Country	:	US
Telephone Number	:	513-556-0648
Fax Number	:	513-556-2302

Provider Business Practice Location Address
First Line	:	225 CALHOUN STREET
Second Line	:	SUITE 200
City	:	CINCINNATI
State	:	OH
Zip	:	45219-1528
Country	:	US
Telephone Number	:	513-556-0648
Fax Number	:	513-556-2302

Authorized Official
Title or Position	:	RECORDS MGMT OFFICER
Name	:	MRS. KIM D JACKSON
Credential	:
Telephone Number	:	513-556-0648

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/01/2014

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