Provider Demographics
NPI:1295250546
Name:ABUNDANT LIFE COUNSELING, LLC
Entity type:Organization
Organization Name:ABUNDANT LIFE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINCIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FELLENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPPC-S
Authorized Official - Phone:440-724-5404
Mailing Address - Street 1:13345 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-3534
Mailing Address - Country:US
Mailing Address - Phone:440-724-5404
Mailing Address - Fax:
Practice Address - Street 1:12375 KINSMAN RD UNIT H-12
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:OH
Practice Address - Zip Code:44065-9684
Practice Address - Country:US
Practice Address - Phone:440-724-5404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900653-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty