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General NPI Number Information
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NPI Number | 1215204037
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Entity Type | Organization
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Legal Business Name | MIAMI VALLEY COUNSELING, LLC
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 12 W WENGER RD SUITE B-1
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2754
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Country | US
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Telephone | 937-836-4788
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Fax | 937-836-4799
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Provider Business Mailing Address
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Address Line | 12 W WENGER RD SUITE B-1
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2754
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Country | US
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Telephone | 937-836-4788
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Fax | 937-836-4799
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Authorized Official
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Title or Position | OWNER/OUTPATIENT THERAPIST
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Name | MS. SUSAN BAINBRIDGE
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Credential | LPCC
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Telephone | 937-836-4788
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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 | E-3301
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License Number State | OH
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