Healthcare Provider Details

I. General information

NPI: 1750467916
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF NORTHWESTERN OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 SOUTH MAIN STREET
LIMA OH
45804
US

IV. Provider business mailing address

799 SOUTH MAIN STREET
LIMA OH
45804
US

V. Phone/Fax

Practice location:
  • Phone: 419-229-2222
  • Fax: 419-229-2227
Mailing address:
  • Phone: 419-229-2222
  • Fax: 419-229-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2482362
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: NANCY A YUNKER
Title or Position: PRESIDENT CEO
Credential: SCSW LISW
Phone: 419-243-9178