Provider Demographics
NPI:1063287431
Name:COUNSELING AND NEUROTHERAPY ASSOCIATES LLC
Entity type:Organization
Organization Name:COUNSELING AND NEUROTHERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAUST
Authorized Official - Suffix:
Authorized Official - Credentials:MED/LPCC-S
Authorized Official - Phone:614-879-8067
Mailing Address - Street 1:1375 US HIGHWAY 42 SE STE C
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9548
Mailing Address - Country:US
Mailing Address - Phone:614-879-8067
Mailing Address - Fax:614-503-0899
Practice Address - Street 1:1375 US HIGHWAY 42 SE STE C
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9548
Practice Address - Country:US
Practice Address - Phone:614-879-8067
Practice Address - Fax:614-503-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0181670Medicaid