Provider Demographics
NPI:1851645048
Name:AMESVILLE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:AMESVILLE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:SMYTH
Authorized Official - Suffix:
Authorized Official - Credentials:PCC
Authorized Official - Phone:740-448-2228
Mailing Address - Street 1:12788 NEW ENGLAND RD
Mailing Address - Street 2:
Mailing Address - City:AMESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45711-9327
Mailing Address - Country:US
Mailing Address - Phone:740-448-2228
Mailing Address - Fax:
Practice Address - Street 1:12788 NEW ENGLAND RD
Practice Address - Street 2:
Practice Address - City:AMESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45711-9327
Practice Address - Country:US
Practice Address - Phone:740-448-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008310251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health