Healthcare Provider Details

I. General information

NPI: 1700022639
Provider Name (Legal Business Name): MID-OHIO COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 RIVER RD STE B
GRANVILLE OH
43023-9560
US

IV. Provider business mailing address

905 RIVER RD STE B
GRANVILLE OH
43023-9560
US

V. Phone/Fax

Practice location:
  • Phone: 740-507-6707
  • Fax: 740-920-4244
Mailing address:
  • Phone: 740-507-6707
  • Fax: 740-920-4244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberI.0500036-SUPV
License Number StateOH

VIII. Authorized Official

Name: KAREN S. COWIE
Title or Position: THERAPIST
Credential: LISW-S, LICDC
Phone: 740-507-6707