MEDICARE: MARRIAGE & FAM MATTERS COUNSELING AND EDUCATION 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	1041C0700X	Clinical Social Worker
2	101YP2500X	Professional 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	:	1942650965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARRIAGE & FAM MATTERS COUNSELING AND EDUCATION SERVICES LLC

Provider Business Mailing Address
First Line	:	8300 PRINCETON GLENDALE RD STE 105
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1677
Country	:	US
Telephone Number	:	513-714-4430
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 PRINCETON GLENDALE RD STE 105
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1677
Country	:	US
Telephone Number	:	513-714-4430
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICHOLE S HICKMAN
Credential	:	LPCC
Telephone Number	:	513-420-4522

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	01/06/2023

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