=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598359507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RECLAIM COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2021
-----------------------------------------------------
Last Update Date | 06/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 804 W RUSSELL RD
-----------------------------------------------------
City | SIDNEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45365-9063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-710-4272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3210 LEATHERWOOD CREEK RD
-----------------------------------------------------
City | SIDNEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45365-9491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-999-8787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LPC
-----------------------------------------------------
Name | EMILY MARIE SHERWOOD
-----------------------------------------------------
Credential | M.A, LPC, NCC
-----------------------------------------------------
Telephone | 937-999-8787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------