Provider Demographics
NPI:1679822829
Name:PERRYSBURG COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PERRYSBURG COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MRC, CRC, LPCC
Authorized Official - Phone:419-482-8382
Mailing Address - Street 1:26494 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5484
Mailing Address - Country:US
Mailing Address - Phone:419-482-8382
Mailing Address - Fax:
Practice Address - Street 1:26471 SOUTHPOINT RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1371
Practice Address - Country:US
Practice Address - Phone:419-482-8382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty