Provider Demographics
NPI:1275718439
Name:FOREST HILLS COUNSELING CARE,
Entity Type:Organization
Organization Name:FOREST HILLS COUNSELING CARE,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:513-232-3400
Mailing Address - Street 1:7495 STATE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2498
Mailing Address - Country:US
Mailing Address - Phone:513-232-3400
Mailing Address - Fax:513-232-1900
Practice Address - Street 1:7495 STATE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2498
Practice Address - Country:US
Practice Address - Phone:513-232-3400
Practice Address - Fax:513-232-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0002275101YM0800X
OH35053195K2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000554980OtherANTHEM PIN
OH000000554980OtherANTHEM PIN