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General NPI Number Information
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NPI Number | 1417798778
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Entity Type | Organization
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Legal Business Name | WILD ROSE COUNSELING LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 215 BUCKLICK CREEK RD
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City | MINFORD
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State | OH
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Zip | 45653-8882
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Country | US
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Telephone | 740-978-8526
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 806
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City | JACKSON
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State | OH
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Zip | 45640-0806
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Country | US
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Telephone | 740-978-8526
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KASEY BENTHIN-STALEY
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Credential | MSW, LISW-S
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Telephone | 740-402-1142
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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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