Provider Demographics
NPI:1780278705
Name:SHAWNEE COUNSELING CENTER LLC
Entity type:Organization
Organization Name:SHAWNEE COUNSELING CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:FANSLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPM
Authorized Official - Phone:863-473-2083
Mailing Address - Street 1:519 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3933
Mailing Address - Country:US
Mailing Address - Phone:740-876-4370
Mailing Address - Fax:740-529-1818
Practice Address - Street 1:519 COURT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3933
Practice Address - Country:US
Practice Address - Phone:740-876-4370
Practice Address - Fax:740-529-1818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWNEE COUNSELING CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-22
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0353310Medicaid