Provider Demographics
NPI:1376054312
Name:LIBERTY COUNSELING & CONSULTATION LLC
Entity Type:Organization
Organization Name:LIBERTY COUNSELING & CONSULTATION LLC
Other - Org Name:LIBERTY COUNSELING & CONSULTATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CHERI
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW, LICDC
Authorized Official - Phone:614-432-4988
Mailing Address - Street 1:4840 LOBLOLLY DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7010
Mailing Address - Country:US
Mailing Address - Phone:614-321-9298
Mailing Address - Fax:614-437-4075
Practice Address - Street 1:4701 OLENTANGY RIVER RD STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1939
Practice Address - Country:US
Practice Address - Phone:614-321-9298
Practice Address - Fax:614-437-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17003141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty