Basic Information
| Provider Information | |||||||||
| NPI: | 1730168097 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARIS COUNSELING AND PSYCHOLOGICAL SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 S BROAD ST | ||||||||
| Address2: | STE 234 | ||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406548716 | ||||||||
| FaxNumber: | 7406539252 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 S BROAD ST | ||||||||
| Address2: | STE 234 | ||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406548716 | ||||||||
| FaxNumber: | 7406548716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER - PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7406548716 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0400X | 3138 | OH | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TC0700X | 3138 | OH | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | 3138 | OH | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
| ID | Type | State | Issuer | Description | 11604000 | 01 | OH | INS | OTHER | 6197702 | 01 | OH | INS | OTHER | 000000330495 | 01 | OH | INS | OTHER | 56546699000 | 01 | OH | BWC | OTHER |