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General NPI Number Information
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NPI Number | 1356160394
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Entity Type | Organization
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Legal Business Name | PREMIERE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1070 COMMERCE DRIVE BUILDING ONE, SUITE 101
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City | PERRYSBURG
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State | OH
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Zip | 43551
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Country | US
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Telephone | 419-482-8382
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 COMMERCE DRIVE BUILDING ONE, SUITE 101
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City | PERRYSBURG
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State | OH
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Zip | 43551
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Country | US
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Telephone | 419-482-8382
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | DR. DEREK LEE
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Credential | PH.D.
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Telephone | 419-482-8382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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