Provider Demographics
NPI:1568521300
Name:SAMARITAN HOUSE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:SAMARITAN HOUSE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-526-4603
Mailing Address - Street 1:PO BOX 1573
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44901-1573
Mailing Address - Country:US
Mailing Address - Phone:419-526-4603
Mailing Address - Fax:419-526-4603
Practice Address - Street 1:87 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-1672
Practice Address - Country:US
Practice Address - Phone:419-526-4603
Practice Address - Fax:419-526-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-1662101Y00000X, 101YM0800X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty