Provider Demographics
NPI:1285687897
Name:WESTERN RESERVE COUNSELING SERVICE, INC.
Entity Type:Organization
Organization Name:WESTERN RESERVE COUNSELING SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, ACSW, BCD
Authorized Official - Phone:440-352-8954
Mailing Address - Street 1:1 VICTORIA PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3406
Mailing Address - Country:US
Mailing Address - Phone:440-352-8954
Mailing Address - Fax:440-352-0351
Practice Address - Street 1:1 VICTORIA PL
Practice Address - Street 2:SUITE 105
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3406
Practice Address - Country:US
Practice Address - Phone:440-352-8954
Practice Address - Fax:440-352-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC2506Medicaid
OH03455Medicare UPIN
OH9248011Medicare ID - Type Unspecified
OHMC2506Medicaid