Provider Demographics
NPI:1295591659
Name:COURTAD-HOLMAN COUNSELING LLC
Entity type:Organization
Organization Name:COURTAD-HOLMAN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTAD-HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:419-294-8570
Mailing Address - Street 1:5178 TOWNSHIP HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-9716
Mailing Address - Country:US
Mailing Address - Phone:419-294-8570
Mailing Address - Fax:
Practice Address - Street 1:625 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1037
Practice Address - Country:US
Practice Address - Phone:419-294-8570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0026914Medicaid