Provider Demographics
NPI:1396043360
Name:BAYSHORE COUNSELING SERVICES
Entity type:Organization
Organization Name:BAYSHORE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:419-626-9156
Mailing Address - Street 1:1218 CLEVELAND RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4200
Mailing Address - Country:US
Mailing Address - Phone:419-626-9156
Mailing Address - Fax:419-621-0099
Practice Address - Street 1:1218 CLEVELAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4200
Practice Address - Country:US
Practice Address - Phone:419-626-9156
Practice Address - Fax:419-621-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100252251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health