Healthcare Provider Details

I. General information

NPI: 1619254687
Provider Name (Legal Business Name): HARRISON FAMILY COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 HARRISON AVE SUITE 205 A
HARRISON OH
45030-2503
US

IV. Provider business mailing address

1150 HARRISON AVE SUITE 205 A
HARRISON OH
45030-2503
US

V. Phone/Fax

Practice location:
  • Phone: 513-367-6823
  • Fax: 513-367-2489
Mailing address:
  • Phone: 513-367-6823
  • Fax: 513-367-2489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000565A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0014199
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001373A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF.0000074
License Number StateOH

VIII. Authorized Official

Name: LINDA M. FREEMAN
Title or Position: M.S.
Credential:
Phone: 513-367-6823