Provider Demographics
NPI:1467709170
Name:BLUE STAR FAMILY COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:BLUE STAR FAMILY COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRESTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-282-4301
Mailing Address - Street 1:2996 STATE ROUTE 5
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9201
Mailing Address - Country:US
Mailing Address - Phone:330-282-4301
Mailing Address - Fax:330-282-4306
Practice Address - Street 1:2996 STATE ROUTE 5
Practice Address - Street 2:SUITE B
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9201
Practice Address - Country:US
Practice Address - Phone:330-282-4301
Practice Address - Fax:330-282-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0501059-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty