Healthcare Provider Details

I. General information

NPI: 1215975685
Provider Name (Legal Business Name): COUNSELING CENTER OF WAYNE & HOLMES COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 BENDEN DR
WOOSTER OH
44691-2568
US

IV. Provider business mailing address

2285 BENDEN DR
WOOSTER OH
44691-2568
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-9029
  • Fax: 330-263-7251
Mailing address:
  • Phone: 330-264-9029
  • Fax: 330-263-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN D. BERRY
Title or Position: PRESIDENT/CEO
Credential: PSY.D.
Phone: 330-264-9029