Provider Demographics
NPI:1659712859
Name:FUENTES COUNSELING SERVICES
Entity Type:Organization
Organization Name:FUENTES COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:PCC, LICDC-CS
Authorized Official - Phone:440-488-4081
Mailing Address - Street 1:36 PUBLIC SQ
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7854
Mailing Address - Country:US
Mailing Address - Phone:440-488-4081
Mailing Address - Fax:
Practice Address - Street 1:36 PUBLIC SQ
Practice Address - Street 2:SUITE 202
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7854
Practice Address - Country:US
Practice Address - Phone:440-488-4081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE8454101YP2500X, 261QM0850X
261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health