Provider Demographics
NPI:1316973431
Name:AMIGO FAMILY COUNSELING LLC
Entity type:Organization
Organization Name:AMIGO FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-358-1643
Mailing Address - Street 1:355 E. CAMPUS VIEW BLVD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5971
Mailing Address - Country:US
Mailing Address - Phone:614-310-1234
Mailing Address - Fax:614-310-1237
Practice Address - Street 1:355 E. CAMPUS VIEW BLVD.
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5971
Practice Address - Country:US
Practice Address - Phone:614-310-1234
Practice Address - Fax:614-310-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAMPC12284Medicare PIN
OH9363421Medicare PIN
OHBASW27943Medicare PIN