Provider Demographics
NPI:1750467916
Name:LUTHERAN SOCIAL SERVICES OF NORTHWESTERN OHIO
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF NORTHWESTERN OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:YUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:SCSW LISW
Authorized Official - Phone:419-243-9178
Mailing Address - Street 1:799 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804
Mailing Address - Country:US
Mailing Address - Phone:419-229-2222
Mailing Address - Fax:419-229-2227
Practice Address - Street 1:799 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804
Practice Address - Country:US
Practice Address - Phone:419-229-2222
Practice Address - Fax:419-229-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
101YM0800X, 1041C0700X, 106H00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2482362Medicaid
OH9276532Medicare PIN