Healthcare Provider Details

I. General information

NPI: 1891942116
Provider Name (Legal Business Name): MARTHA MCLEOD COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 WOOLPER AVE
CINCINNATI OH
45220-1217
US

IV. Provider business mailing address

211 WOOLPER AVE
CINCINNATI OH
45220-1217
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-8623
  • Fax: 513-221-8623
Mailing address:
  • Phone: 513-221-8623
  • Fax: 513-221-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberI4537
License Number StateOH

VIII. Authorized Official

Name: MS. MARTHA ELIZABETH MCLEOD
Title or Position: LICENSED INDEPENDENT SOCIAL WRKER
Credential: MA, LISW, LCSW
Phone: 513-221-8623