Provider Demographics
NPI:1558425363
Name:UNIVERSITY OF CINCINNATI COUNSELING & PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:UNIVERSITY OF CINCINNATI COUNSELING & PSYCHOLOGICAL SERVICES
Other - Org Name:COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:RECORDS MGMT OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-556-0648
Mailing Address - Street 1:MAIL LOCATION 0034
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45221-0034
Mailing Address - Country:US
Mailing Address - Phone:513-556-0648
Mailing Address - Fax:513-556-2302
Practice Address - Street 1:225 CALHOUN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1528
Practice Address - Country:US
Practice Address - Phone:513-556-0648
Practice Address - Fax:513-556-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
OH6911103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty