Provider Demographics
NPI:1023362431
Name:COUNSELING RESOURCE CENTER OF MASON, LLC
Entity Type:Organization
Organization Name:COUNSELING RESOURCE CENTER OF MASON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBSTORFF
Authorized Official - Suffix:
Authorized Official - Credentials:PCC-S
Authorized Official - Phone:513-288-8815
Mailing Address - Street 1:5670 EAGLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-7200
Mailing Address - Country:US
Mailing Address - Phone:513-288-8815
Mailing Address - Fax:513-229-8963
Practice Address - Street 1:7577 CENTRAL PARKE BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6810
Practice Address - Country:US
Practice Address - Phone:513-288-8815
Practice Address - Fax:513-229-8963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.00004149251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health