Basic Information
| Provider Information | |||||||||
| NPI: | 1023775509 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANAHATA COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7433 CLOVERNOOK AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452314427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375444020 | ||||||||
| FaxNumber: | 9375444009 | ||||||||
| Practice Location | |||||||||
| Address1: | 7433 CLOVERNOOK AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452314427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375444020 | ||||||||
| FaxNumber: | 9375444009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2021 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LATHAM | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9375444020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CREDENTIALING | ||||||||
| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 161970 | 01 | OH | LICENSE | OTHER | C.1902037 | 01 | OH | LICENSE | OTHER |