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General NPI Number Information
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NPI Number | 1174957815
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Entity Type | Organization
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Legal Business Name | WESTERN RESERVE COUNSELING
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 1 VICTORIA PL SUITE 105
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City | PAINESVILLE
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State | OH
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Zip | 44077-3466
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Country | US
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Telephone | 440-352-8954
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Fax | 440-352-0351
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Provider Business Mailing Address
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Address Line | 1 VICTORIA PL SUITE 105
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City | PAINESVILLE
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State | OH
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Zip | 44077-3466
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Country | US
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Telephone | 440-352-8954
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Fax | 440-352-0351
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. KELLY SUE CHRISTY
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Credential | LPCC-S
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Telephone | 440-352-8954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | E0002543
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License Number State | OH
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