Provider Demographics
NPI:1235582347
Name:NEWPORT COUNSELING, LLC
Entity Type:Organization
Organization Name:NEWPORT COUNSELING, LLC
Other - Org Name:KRISTA WASSER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MAED,LPCC;LICDC-CS
Authorized Official - Phone:330-286-4008
Mailing Address - Street 1:132 S BROAD ST
Mailing Address - Street 2:SUITE 401B
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1442
Mailing Address - Country:US
Mailing Address - Phone:330-286-4008
Mailing Address - Fax:330-286-4008
Practice Address - Street 1:132 S BROAD ST
Practice Address - Street 2:SUITE 401B
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1442
Practice Address - Country:US
Practice Address - Phone:330-286-4008
Practice Address - Fax:330-286-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0800048101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
OHICDC.161123-CS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty