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General NPI Number Information
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NPI Number | 1205379138
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Entity Type | Organization
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Legal Business Name | COUNSELING AND ASSESSMENT CENTER
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Dates
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Enumeration Date | 11/26/2016
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Last Update Date | 11/26/2016
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Provider Practice Location Address
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Address Line | 3608 ORCHARD TRAIL DR
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City | TOLEDO
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State | OH
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Zip | 43606-1149
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Country | US
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Telephone | 419-202-4137
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Fax |
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Provider Business Mailing Address
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Address Line | 3608 ORCHARD TRAIL DR
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City | TOLEDO
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State | OH
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Zip | 43606-1149
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Country | US
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Telephone | 419-202-4137
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | TERRI LYNN KERN
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Credential | LPC
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Telephone | 419-202-4137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.1400458
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License Number State | OH
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