Provider Demographics
NPI:1154747061
Name:PROFESSIONAL COUNSELING
Entity type:Organization
Organization Name:PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:513-242-4235
Mailing Address - Street 1:10901 REED HARTMAN HWY
Mailing Address - Street 2:SUITE #108
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2831
Mailing Address - Country:US
Mailing Address - Phone:513-473-3110
Mailing Address - Fax:
Practice Address - Street 1:10901 REED HARTMAN HWY
Practice Address - Street 2:SUITE #108
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2831
Practice Address - Country:US
Practice Address - Phone:513-473-3110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL.00035711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty