Healthcare Provider Details

I. General information

NPI: 1093257859
Provider Name (Legal Business Name): ON DEMAND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 PATRIOT BLVD STE C
AUSTINTOWN OH
44515-1170
US

IV. Provider business mailing address

5760 PATRIOT BLVD STE D
AUSTINTOWN OH
44515-1170
US

V. Phone/Fax

Practice location:
  • Phone: 330-270-8610
  • Fax: 330-270-2690
Mailing address:
  • Phone: 330-270-8610
  • Fax: 330-270-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: THOMAS IVANY
Title or Position: CEO
Credential:
Phone: 330-270-3660