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General NPI Number Information
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NPI Number | 1003361734
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Entity Type | Organization
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Legal Business Name | MIGHTY OAK CHRISTIAN COUNSELING LLC
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 441 FRAZEE AVE STE A
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City | BOWLING GREEN
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State | OH
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Zip | 43402-1886
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Country | US
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Telephone | 419-575-7910
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Fax | 419-386-0951
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Provider Business Mailing Address
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Address Line | 441 FRAZEE AVE STE A
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City | BOWLING GREEN
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State | OH
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Zip | 43402-1886
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Country | US
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Telephone | 419-575-7910
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Fax | 419-386-0951
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Authorized Official
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Title or Position | PROFESSIONAL CLINICAL COUNSELOR
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Name | LINANN M TEGGART
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Credential | LPCC-S
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Telephone | 419-575-7910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C00900343
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License Number State | OH
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