Provider Demographics
NPI:1487646865
Name:PAULDING COUNSELING CENTER
Entity Type:Organization
Organization Name:PAULDING COUNSELING CENTER
Other - Org Name:PAULDING COUNTY MENTAL HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-399-3636
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-0329
Mailing Address - Country:US
Mailing Address - Phone:419-399-3636
Mailing Address - Fax:419-399-5915
Practice Address - Street 1:501 MCDONALD PIKE
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879
Practice Address - Country:US
Practice Address - Phone:419-399-3636
Practice Address - Fax:419-399-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC-48-03-00Medicaid
OH324541Medicare UPIN
OH9236191Medicare ID - Type Unspecified