Provider Demographics
NPI:1669698403
Name:COUNSELING SERVICES AND CONSULTING, LLC
Entity type:Organization
Organization Name:COUNSELING SERVICES AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WIHEBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, MAC, SAP
Authorized Official - Phone:260-432-9916
Mailing Address - Street 1:4660 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6845
Mailing Address - Country:US
Mailing Address - Phone:260-432-9916
Mailing Address - Fax:
Practice Address - Street 1:4660 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6845
Practice Address - Country:US
Practice Address - Phone:260-432-9916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health