Healthcare Provider Details

I. General information

NPI: 1174307334
Provider Name (Legal Business Name): WESTSIDE COUNSELING SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4254 LOUBELL LN
CINCINNATI OH
45205-2035
US

IV. Provider business mailing address

4254 LOUBELL LN
CINCINNATI OH
45205-2035
US

V. Phone/Fax

Practice location:
  • Phone: 513-202-3657
  • Fax:
Mailing address:
  • Phone: 513-202-3657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ERVIN HENDERSON
Title or Position: MANAGER AND CEO
Credential: LPCC
Phone: 513-202-3657