Provider Demographics
NPI:1073935649
Name:PROFESSIONAL COUNSELING SERVICES OF OHIO LLC
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING SERVICES OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:URBANAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPCC
Authorized Official - Phone:937-742-7516
Mailing Address - Street 1:300 JAMES BOHANAN DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2300
Mailing Address - Country:US
Mailing Address - Phone:937-742-7516
Mailing Address - Fax:937-415-0152
Practice Address - Street 1:300 JAMES BOHANAN DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2300
Practice Address - Country:US
Practice Address - Phone:937-742-7516
Practice Address - Fax:937-415-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty