Basic Information
| Provider Information | |||||||||
| NPI: | 1609222793 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY LIFE COUNSELING | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 222 MARION AVE | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449032138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675603582 | ||||||||
| FaxNumber: | 5675604484 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 MARION AVE | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449032138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675603582 | ||||||||
| FaxNumber: | 5675604484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2016 | ||||||||
| LastUpdateDate: | 05/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 5675603582 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | S0017427 | OH | Y | Agencies | Community/Behavioral Health |
No ID Information.