Provider Demographics
NPI:1144789611
Name:EARLY CHILDHOOD COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:EARLY CHILDHOOD COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERNATH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCC-S
Authorized Official - Phone:513-295-6182
Mailing Address - Street 1:3208 ROBINA LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-8679
Mailing Address - Country:US
Mailing Address - Phone:513-757-9433
Mailing Address - Fax:513-824-8129
Practice Address - Street 1:4947 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3908
Practice Address - Country:US
Practice Address - Phone:513-757-9433
Practice Address - Fax:513-824-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0205973Medicaid