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General NPI Number Information
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NPI Number | 1083027510
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Entity Type | Organization
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Legal Business Name | QUEEN CITY COUNSELING SERVICES
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 9429 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45242-7602
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Country | US
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Telephone | 513-259-6202
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 541191
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City | CINCINNATI
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State | OH
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Zip | 45254-1191
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Country | US
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Telephone | 513-259-6202
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. JENNIFER REYNOLDS
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Credential | IMFT ATR-BC
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Telephone | 513-259-6202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | F1200009
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License Number State | OH
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