Provider Demographics
NPI:1336249192
Name:FAMILYCARE COUNSELING CENTER
Entity Type:Organization
Organization Name:FAMILYCARE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COBLENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-893-2100
Mailing Address - Street 1:P. O. BOX 158
Mailing Address - Street 2:5130 TR 359
Mailing Address - City:BERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44610
Mailing Address - Country:US
Mailing Address - Phone:330-893-2100
Mailing Address - Fax:330-893-3732
Practice Address - Street 1:5130 TR 359
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:OH
Practice Address - Zip Code:44610
Practice Address - Country:US
Practice Address - Phone:330-893-2100
Practice Address - Fax:330-893-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4532103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty