Provider Demographics
NPI:1356831432
Name:OHIO FAMILY COUNSELING AND RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:OHIO FAMILY COUNSELING AND RECOVERY SERVICES, LLC
Other - Org Name:OHIO FAMILIY COUNSELING AND RECOVERY SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF QUALITY ASSURANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-565-9742
Mailing Address - Street 1:17325 EUCLID AVE STE 4028
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1270
Mailing Address - Country:US
Mailing Address - Phone:803-565-9742
Mailing Address - Fax:
Practice Address - Street 1:17325 EUCLID AVE STE 3026
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1255
Practice Address - Country:US
Practice Address - Phone:803-565-9742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID NUMBER