=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114290228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AURORA COUNSELING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2012
-----------------------------------------------------
Last Update Date | 02/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 199 S CHILLICOTHE RD SUITE 208
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44202-8830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-870-8888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 CHADWICK DR
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44202-6640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-870-8888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JONATHAN ALLAN NATKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-870-8888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------