Provider Demographics
NPI:1639654288
Name:OHIO FAMILY COUNSELING AND CONSULTATION, LLC
Entity Type:Organization
Organization Name:OHIO FAMILY COUNSELING AND CONSULTATION, LLC
Other - Org Name:OHIO FAMILY COUNSELING AND CONSULTATION, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEHRMAN RIDENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, LICDC-CS
Authorized Official - Phone:740-291-3737
Mailing Address - Street 1:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-6311
Mailing Address - Country:US
Mailing Address - Phone:740-291-3737
Mailing Address - Fax:
Practice Address - Street 1:550 MAIN ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1612
Practice Address - Country:US
Practice Address - Phone:740-291-3737
Practice Address - Fax:833-805-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-29
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0202860Medicaid