=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316432636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY CHRISTIAN COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2018
-----------------------------------------------------
Last Update Date | 04/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 S MAIN ST STE 305
-----------------------------------------------------
City | FOSTORIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44830-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-429-1000
-----------------------------------------------------
Fax | 419-436-7460
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 S MAIN ST STE 305
-----------------------------------------------------
City | FOSTORIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44830-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-249-1000
-----------------------------------------------------
Fax | 419-436-7460
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL DIRECTOR
-----------------------------------------------------
Name | TECKY ANN RUSK
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 567-429-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E.1800504
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------