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General NPI Number Information
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NPI Number | 1659712859
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Entity Type | Organization
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Legal Business Name | FUENTES COUNSELING SERVICES
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 36 PUBLIC SQ SUITE 202
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City | WILLOUGHBY
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State | OH
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Zip | 44094-7854
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Country | US
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Telephone | 440-488-4081
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Fax |
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Provider Business Mailing Address
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Address Line | 36 PUBLIC SQ SUITE 202
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City | WILLOUGHBY
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State | OH
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Zip | 44094-7854
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Country | US
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Telephone | 440-488-4081
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Fax |
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Authorized Official
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Title or Position | CLINICIAN/ OWNER
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Name | MRS. DEBRA L FUENTES
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Credential | PCC, LICDC-CS
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Telephone | 440-488-4081
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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 | E8454
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | E8454
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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