Provider Demographics
NPI:1124015524
Name:WOOD COUNTY CHILDREN'S SERVICES ASSOCIATION
Entity Type:Organization
Organization Name:WOOD COUNTY CHILDREN'S SERVICES ASSOCIATION
Other - Org Name:CHILDREN'S RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNEESSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-352-7588
Mailing Address - Street 1:1045 KLOTZ RD
Mailing Address - Street 2:P.O. BOX 738
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4820
Mailing Address - Country:US
Mailing Address - Phone:419-352-7588
Mailing Address - Fax:419-354-4977
Practice Address - Street 1:1045 KLOTZ RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4820
Practice Address - Country:US
Practice Address - Phone:419-352-7588
Practice Address - Fax:419-354-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0388736Medicaid