Healthcare Provider Details

I. General information

NPI: 1295591659
Provider Name (Legal Business Name): COURTAD-HOLMAN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N SANDUSKY AVE
UPPER SANDUSKY OH
43351-1037
US

IV. Provider business mailing address

5178 TOWNSHIP HIGHWAY 55
UPPER SANDUSKY OH
43351-9716
US

V. Phone/Fax

Practice location:
  • Phone: 419-294-8570
  • Fax:
Mailing address:
  • Phone: 419-294-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JODI COURTAD-HOLMAN
Title or Position: OWNER
Credential: MA
Phone: 419-294-8570