MEDICARE: SPRING VALLEY COUNSELING SERVICES LLC

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

General Provider Information

NPI Number	:	1447006929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING VALLEY COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	5526 DORR ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3612
Country	:	US
Telephone Number	:	419-262-0189
Fax Number	:

Provider Business Practice Location Address
First Line	:	6545 W CENTRAL AVE STE 202
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-1034
Country	:	US
Telephone Number	:	567-343-3377
Fax Number	:	567-316-6455

Authorized Official
Title or Position	:	LICENSED INDEPENDENT SOCIAL WORKER
Name	:	BROOKE FORCHE
Credential	:	LISW, MSW
Telephone Number	:	419-262-0189

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	11/11/2024

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