Provider Demographics
NPI:1760741656
Name:COLUMBIANA COUNTY MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:COLUMBIANA COUNTY MENTAL HEALTH CLINIC
Other - Org Name:THE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIKORSZKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-424-7761
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-0429
Mailing Address - Country:US
Mailing Address - Phone:330-424-9573
Mailing Address - Fax:330-424-0877
Practice Address - Street 1:40722 STATE ROUTE 154
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8500
Practice Address - Country:US
Practice Address - Phone:330-424-9573
Practice Address - Fax:330-424-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2504261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2863905Medicaid