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General NPI Number Information
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NPI Number | 1538846902
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Entity Type | Organization
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Legal Business Name | BROOK RUN COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 3666 PARK AVE W
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City | ONTARIO
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State | OH
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Zip | 44903-9107
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Country | US
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Telephone | 419-632-0588
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Fax | 888-522-4535
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Provider Business Mailing Address
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Address Line | PO BOX 102
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City | ONTARIO
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State | OH
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Zip | 44862-0102
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Country | US
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Telephone | 419-632-0588
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Fax | 888-522-4535
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Authorized Official
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Title or Position | OWNER
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Name | MS. JILL A. WAITE
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Credential | LPCC-S
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Telephone | 419-632-0588
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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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