MEDICARE: PROFESSIONAL COUNSELING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L.0003571	OH

General Provider Information

NPI Number	:	1154747061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL COUNSELING

Provider Business Mailing Address
First Line	:	10901 REED HARTMAN HWY
Second Line	:	SUITE #108
City	:	BLUE ASH
State	:	OH
Zip	:	45242-2831
Country	:	US
Telephone Number	:	513-473-3110
Fax Number	:

Provider Business Practice Location Address
First Line	:	10901 REED HARTMAN HWY
Second Line	:	SUITE #108
City	:	BLUE ASH
State	:	OH
Zip	:	45242-2831
Country	:	US
Telephone Number	:	513-473-3110
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	LILLIE J MARTIN
Credential	:	LISW-S
Telephone Number	:	513-242-4235

Provider Enumeration Date	:	03/16/2014
Last Update Date	:	03/16/2014

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