Provider Demographics
NPI:1205379138
Name:COUNSELING AND ASSESSMENT CENTER
Entity Type:Organization
Organization Name:COUNSELING AND ASSESSMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:419-202-4137
Mailing Address - Street 1:3608 ORCHARD TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1149
Mailing Address - Country:US
Mailing Address - Phone:419-202-4137
Mailing Address - Fax:
Practice Address - Street 1:3608 ORCHARD TRAIL DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1149
Practice Address - Country:US
Practice Address - Phone:419-202-4137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-26
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty