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General NPI Number Information
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NPI Number | 1669698403
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Entity Type | Organization
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Legal Business Name | COUNSELING SERVICES AND CONSULTING, LLC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4660 W JEFFERSON BLVD SUITE 200
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City | FORT WAYNE
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State | IN
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Zip | 46804-6845
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Country | US
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Telephone | 260-432-9916
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Fax |
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Provider Business Mailing Address
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Address Line | 4660 W JEFFERSON BLVD SUITE 200
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City | FORT WAYNE
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State | IN
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Zip | 46804-6845
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Country | US
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Telephone | 260-432-9916
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PROF. JEFFREY LEE WIHEBRINK
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Credential | LMHC, MAC, SAP
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Telephone | 260-432-9916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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