Provider Demographics
NPI:1508827932
Name:COLUMBIANA COUNTY MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:COLUMBIANA COUNTY MENTAL HEALTH CLINIC
Other - Org Name:THE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIKORSZKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-424-7761
Mailing Address - Street 1:40722 STATE ROUTE 154
Mailing Address - Street 2:PO BOX 429
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8500
Mailing Address - Country:US
Mailing Address - Phone:330-424-9573
Mailing Address - Fax:330-424-0877
Practice Address - Street 1:40722 STATE ROUTE 154
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8500
Practice Address - Country:US
Practice Address - Phone:330-424-9573
Practice Address - Fax:330-424-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0118,2504251B00000X, 261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0201696Medicaid
OH1051OtherCOMMUNITY MEDICAID
OH0201696Medicaid