Healthcare Provider Details

I. General information

NPI: 1841421351
Provider Name (Legal Business Name): THE COUNSELING AND COOPERATIVE PARENTING CENTER OF OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 CONGRESS AVE SUITE B
CINCINNATI OH
45246-4484
US

IV. Provider business mailing address

1130 CONGRESS AVE SUITE B
CINCINNATI OH
45246-4484
US

V. Phone/Fax

Practice location:
  • Phone: 513-858-2000
  • Fax: 513-858-2888
Mailing address:
  • Phone: 513-858-2000
  • Fax: 513-858-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0008845
License Number StateOH

VIII. Authorized Official

Name: BRENDA SUE PATTON
Title or Position: PRESIDENT
Credential: LISW-S
Phone: 513-858-2000