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General NPI Number Information
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NPI Number | 1659077121
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Entity Type | Organization
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Legal Business Name | PREMIER CONSULTING TOLEDO LLC
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 701 JEFFERSON AVE STE 203
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City | TOLEDO
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State | OH
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Zip | 43604-6957
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Country | US
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Telephone | 707-391-1752
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Fax |
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Provider Business Mailing Address
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Address Line | 2308 ROBINWOOD AVE APT 1
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City | TOLEDO
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State | OH
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Zip | 43620-1024
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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 | SHAY ELLETHA BANKSTON
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Credential | LISW
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Telephone | 707-391-1752
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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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