Provider Demographics
NPI:1275924391
Name:WESTERN RESERVE COUNSELING LLC
Entity Type:Organization
Organization Name:WESTERN RESERVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LICDC
Authorized Official - Phone:440-822-2248
Mailing Address - Street 1:32831 REDWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1518
Mailing Address - Country:US
Mailing Address - Phone:330-461-2183
Mailing Address - Fax:440-930-2085
Practice Address - Street 1:223 MILLER RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1004
Practice Address - Country:US
Practice Address - Phone:440-822-8248
Practice Address - Fax:440-930-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0050965SUPV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty