Provider Demographics
NPI:1235625229
Name:COVENANT FAMILY WELLNESS, LLC
Entity Type:Organization
Organization Name:COVENANT FAMILY WELLNESS, LLC
Other - Org Name:MISFIT REFUGE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNTER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:614-705-0626
Mailing Address - Street 1:1544 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2649
Mailing Address - Country:US
Mailing Address - Phone:614-260-9545
Mailing Address - Fax:844-222-4587
Practice Address - Street 1:1544 VALLEY DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2649
Practice Address - Country:US
Practice Address - Phone:614-705-0626
Practice Address - Fax:844-222-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1800509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty