Provider Demographics
NPI:1326861329
Name:KINTSUKUROI MENTAL HEALTH & WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:KINTSUKUROI MENTAL HEALTH & WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PROFESSIONAL CLINICAL COUN
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:419-787-3780
Mailing Address - Street 1:1351 S REYNOLDS RD STE B
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1351 S REYNOLDS RD STE B
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7411
Practice Address - Country:US
Practice Address - Phone:419-410-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty