Provider Demographics
NPI:1174957815
Name:WESTERN RESERVE COUNSELING
Entity type:Organization
Organization Name:WESTERN RESERVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:440-352-8954
Mailing Address - Street 1:1 VICTORIA PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3466
Mailing Address - Country:US
Mailing Address - Phone:440-352-8954
Mailing Address - Fax:440-352-0351
Practice Address - Street 1:1 VICTORIA PL
Practice Address - Street 2:SUITE 105
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3466
Practice Address - Country:US
Practice Address - Phone:440-352-8954
Practice Address - Fax:440-352-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002543251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health