Provider Demographics
NPI:1215451158
Name:INTACT COUNSELING GROUP LLC
Entity type:Organization
Organization Name:INTACT COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:GENTILE
Authorized Official - Last Name:EDELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, CSAT
Authorized Official - Phone:513-602-2740
Mailing Address - Street 1:9200 MONTGOMERY RD BLDG D
Mailing Address - Street 2:SUIT 15B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7789
Mailing Address - Country:US
Mailing Address - Phone:513-602-2740
Mailing Address - Fax:
Practice Address - Street 1:9200 MONTGOMERY RD STE 15B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7730
Practice Address - Country:US
Practice Address - Phone:513-602-2740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE100187101YM0800X
OHC0501191101YP2500X
261QM0801X, 261QM0850X, 261QM0855X, 261QM1300X, 261QR0800X
OHE1100187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1851833115OtherPERSONAL NPI