Healthcare Provider Details

I. General information

NPI: 1811665169
Provider Name (Legal Business Name): THE COUNSELING CENTER OF BOARDMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8166 MARKET ST STE N
BOARDMAN OH
44512-6263
US

IV. Provider business mailing address

8166 MARKET ST STE N
BOARDMAN OH
44512-6263
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-7780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JAYMI WENDT
Title or Position: OWNER
Credential:
Phone: 330-726-7780