Provider Demographics
NPI:1306459821
Name:SOUTHEASTERN OHIO COUNSELING CENTER, LLC.
Entity type:Organization
Organization Name:SOUTHEASTERN OHIO COUNSELING CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-489-5571
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:OLD WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43768-0094
Mailing Address - Country:US
Mailing Address - Phone:740-489-5571
Mailing Address - Fax:740-489-5004
Practice Address - Street 1:239A OLD NATIONAL ROAD
Practice Address - Street 2:
Practice Address - City:OLD WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43768
Practice Address - Country:US
Practice Address - Phone:740-489-5571
Practice Address - Fax:740-489-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health