Basic Information
| Provider Information | |||||||||
| NPI: | 1295732543 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHELBY COUNTY COUNSELING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E COURT ST | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453652810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374926970 | ||||||||
| FaxNumber: | 9374926971 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 E COURT ST | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453652810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374926970 | ||||||||
| FaxNumber: | 9374926971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9374926970 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 5486 | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.