Provider Demographics
NPI:1437531597
Name:LIBERATION COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:LIBERATION COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREVIOUS PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:RAMOS
Authorized Official - Last Name:BAUZO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:937-938-0185
Mailing Address - Street 1:2680 EAST MAIN STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168
Mailing Address - Country:US
Mailing Address - Phone:317-551-3374
Mailing Address - Fax:888-375-5415
Practice Address - Street 1:2680 EAST MAIN STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168
Practice Address - Country:US
Practice Address - Phone:317-551-3374
Practice Address - Fax:888-375-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
IN35001827A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty