MEDICARE: SPECIALIZED 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	251S00000X	Community/Behavioral Health Agency	E.0003739	OH

General Provider Information

NPI Number	:	1750668125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1821 SUMMIT RD
Second Line	:	SUITE 202
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2822
Country	:	US
Telephone Number	:	513-404-5521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 SUMMIT RD
Second Line	:	SUITE 202
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2822
Country	:	US
Telephone Number	:	513-404-5521
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	HEIDI ELLEN NUNEMAKER
Credential	:	LPCC
Telephone Number	:	513-404-5521

Provider Enumeration Date	:	11/13/2011
Last Update Date	:	11/13/2011

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