Healthcare Provider Details

I. General information

NPI: 1407478555
Provider Name (Legal Business Name): ABUNDANT LIFE COUNSELING & CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 MAIN ST
HURON OH
44839-1610
US

IV. Provider business mailing address

348 MAIN ST
HURON OH
44839-1610
US

V. Phone/Fax

Practice location:
  • Phone: 419-359-0307
  • Fax: 833-667-6490
Mailing address:
  • Phone: 419-359-0307
  • Fax: 833-667-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NYCOLA ANN BOUCK
Title or Position: OWNER/THERAPIST
Credential: LISW-S
Phone: 419-359-0307