Provider Demographics
NPI:1801088604
Name:GENESIS COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:GENESIS COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FIKTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-543-8880
Mailing Address - Street 1:17747 CHILLICOTHE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4765
Mailing Address - Country:US
Mailing Address - Phone:440-543-8880
Mailing Address - Fax:440-543-5911
Practice Address - Street 1:17747 CHILLICOTHE RD STE 105
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4765
Practice Address - Country:US
Practice Address - Phone:440-543-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0632992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000136790OtherANTHEM BLUE CROSS
OH0147004Medicaid
191762OtherVALUE OPTIONS
5781747OtherAETNA
191762OtherVALUE OPTIONS