Provider Demographics
NPI:1326809450
Name:PROACTIVE COUNSELING LLC
Entity Type:Organization
Organization Name:PROACTIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:847-641-0811
Mailing Address - Street 1:6729 AYLESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3895
Mailing Address - Country:US
Mailing Address - Phone:847-641-0811
Mailing Address - Fax:
Practice Address - Street 1:3628 WALNUT HILLS AVE
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4484
Practice Address - Country:US
Practice Address - Phone:847-641-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)