Healthcare Provider Details

I. General information

NPI: 1215451158
Provider Name (Legal Business Name): INTACT COUNSELING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 MONTGOMERY RD STE 15B
CINCINNATI OH
45242-7730
US

IV. Provider business mailing address

9200 MONTGOMERY RD BLDG D SUIT 15B
CINCINNATI OH
45242-7789
US

V. Phone/Fax

Practice location:
  • Phone: 513-602-2740
  • Fax:
Mailing address:
  • Phone: 513-602-2740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE100187
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0501191
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE1100187
License Number StateOH

VIII. Authorized Official

Name: JANE GENTILE EDELMANN
Title or Position: PARTNER
Credential: MA, LPCC, CSAT
Phone: 513-602-2740