MEDICARE: THREE C COUNSELING, INC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1346615010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE C COUNSELING, INC

Provider Business Mailing Address
First Line	:	28 PARK AVE W
Second Line	:	300
City	:	MANSFIELD
State	:	OH
Zip	:	44902-1648
Country	:	US
Telephone Number	:	419-522-5015
Fax Number	:	419-522-5017

Provider Business Practice Location Address
First Line	:	28 PARK AVE W
Second Line	:	300
City	:	MANSFIELD
State	:	OH
Zip	:	44902-1648
Country	:	US
Telephone Number	:	419-522-5015
Fax Number	:	419-522-5017

Authorized Official
Title or Position	:	CEO
Name	:	TIMOTHY BATDORF
Credential	:	LICDC, SAP
Telephone Number	:	419-522-5015

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	12/07/2015

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