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General NPI Number Information
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NPI Number | 1528609054
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Entity Type | Organization
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Legal Business Name | THE IVORY WAY COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 10/06/2019
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Last Update Date | 10/06/2019
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Provider Practice Location Address
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Address Line | 1351 S REYNOLDS RD STE B
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City | TOLEDO
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State | OH
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Zip | 43615-7411
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Country | US
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Telephone | 567-377-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 26342 LAUREL LN
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City | PERRYSBURG
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State | OH
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Zip | 43551-5702
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA ODEH
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Credential |
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Telephone | 567-377-7410
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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 |
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License Number State |
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