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General NPI Number Information
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NPI Number | 1811665169
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Entity Type | Organization
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Legal Business Name | THE COUNSELING CENTER OF BOARDMAN LLC
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 8166 MARKET ST STE N
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City | BOARDMAN
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State | OH
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Zip | 44512-6263
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Country | US
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Telephone | 330-726-7780
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Fax |
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Provider Business Mailing Address
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Address Line | 8166 MARKET ST STE N
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City | BOARDMAN
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State | OH
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Zip | 44512-6263
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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 | JAYMI WENDT
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Credential |
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Telephone | 330-726-7780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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