Provider Demographics
NPI:1437617016
Name:MIND & BODY COUNSELING SOLUTIONS
Entity Type:Organization
Organization Name:MIND & BODY COUNSELING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:M
Authorized Official - Last Name:TELEGO
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:330-397-8001
Mailing Address - Street 1:34 FAIRLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-1561
Mailing Address - Country:US
Mailing Address - Phone:330-397-8001
Mailing Address - Fax:
Practice Address - Street 1:34 FAIRLAWN AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-1561
Practice Address - Country:US
Practice Address - Phone:330-397-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-03
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0344066Medicaid
OH0215964Medicaid