Provider Demographics
NPI:1164287546
Name:KNOWN BY NAME COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:KNOWN BY NAME COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:KILBANE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:304-238-4074
Mailing Address - Street 1:1031 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5709
Mailing Address - Country:US
Mailing Address - Phone:304-238-4074
Mailing Address - Fax:
Practice Address - Street 1:1031 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5709
Practice Address - Country:US
Practice Address - Phone:304-238-4074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical