Provider Demographics
NPI:1902837636
Name:LIFEWAY COUNSELING CENTERS, INC.
Entity Type:Organization
Organization Name:LIFEWAY COUNSELING CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-744-4610
Mailing Address - Street 1:11161 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-1817
Mailing Address - Country:US
Mailing Address - Phone:513-769-4600
Mailing Address - Fax:513-769-0304
Practice Address - Street 1:11161 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-1817
Practice Address - Country:US
Practice Address - Phone:513-769-4600
Practice Address - Fax:513-769-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9286111Medicare PIN