Provider Demographics
NPI:1003534843
Name:MEDELLA COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:MEDELLA COUNSELING SERVICES LLC
Other - Org Name:MEDELLA COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-398-7431
Mailing Address - Street 1:7700 STATE ROUTE 42 S
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9401
Mailing Address - Country:US
Mailing Address - Phone:740-398-7431
Mailing Address - Fax:
Practice Address - Street 1:7700 STATE ROUTE 42 S
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44904-9401
Practice Address - Country:US
Practice Address - Phone:740-398-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0166847Medicaid
OH0166326Medicaid