Healthcare Provider Details

I. General information

NPI: 1336249192
Provider Name (Legal Business Name): FAMILYCARE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 TR 359
BERLIN OH
44610
US

IV. Provider business mailing address

P. O. BOX 158 5130 TR 359
BERLIN OH
44610
US

V. Phone/Fax

Practice location:
  • Phone: 330-893-2100
  • Fax: 330-893-3732
Mailing address:
  • Phone: 330-893-2100
  • Fax: 330-893-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4532
License Number StateOH

VIII. Authorized Official

Name: DR. ELVIN B COBLENTZ
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 330-893-2100