Provider Demographics
NPI:1316432636
Name:SERENITY CHRISTIAN COUNSELING
Entity type:Organization
Organization Name:SERENITY CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TECKY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUSK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:567-429-1000
Mailing Address - Street 1:125 S MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2361
Mailing Address - Country:US
Mailing Address - Phone:567-249-1000
Mailing Address - Fax:419-436-7460
Practice Address - Street 1:125 S MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-2361
Practice Address - Country:US
Practice Address - Phone:567-429-1000
Practice Address - Fax:419-436-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800504101YP2500X
101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0324034Medicaid