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General NPI Number Information
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NPI Number | 1407478555
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE COUNSELING & CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 348 MAIN ST
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City | HURON
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State | OH
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Zip | 44839-1610
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Country | US
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Telephone | 419-359-0307
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Fax | 833-667-6490
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Provider Business Mailing Address
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Address Line | 348 MAIN ST
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City | HURON
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State | OH
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Zip | 44839-1610
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Country | US
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Telephone | 419-359-0307
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Fax | 833-667-6490
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | NYCOLA ANN BOUCK
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Credential | LISW-S
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Telephone | 419-359-0307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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