MEDICARE: ON DEMAND COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician
3	324500000X	Substance Abuse Rehabilitation Facility
4	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093257859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON DEMAND COUNSELING LLC

Provider Business Mailing Address
First Line	:	5760 PATRIOT BLVD STE D
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-1170
Country	:	US
Telephone Number	:	330-270-8610
Fax Number	:	330-270-2690

Provider Business Practice Location Address
First Line	:	5760 PATRIOT BLVD STE C
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-1170
Country	:	US
Telephone Number	:	330-270-8610
Fax Number	:	330-270-2690

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS IVANY
Credential	:
Telephone Number	:	330-270-3660

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	06/02/2020

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Directions to “ON DEMAND COUNSELING LLC ” Practice Location

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