Provider Demographics
NPI:1962557132
Name:NORTH OLMSTED FAMILY COUNSELING SVC LLC
Entity type:Organization
Organization Name:NORTH OLMSTED FAMILY COUNSELING SVC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSCA CISW
Authorized Official - Phone:513-770-3231
Mailing Address - Street 1:26777 LORAIN RD
Mailing Address - Street 2:#308
Mailing Address - City:NORTH OLMSTEAD
Mailing Address - State:OH
Mailing Address - Zip Code:44070
Mailing Address - Country:US
Mailing Address - Phone:440-779-9565
Mailing Address - Fax:440-779-0437
Practice Address - Street 1:26777 LORAIN RD
Practice Address - Street 2:#308
Practice Address - City:NORTH OLMSTEAD
Practice Address - State:OH
Practice Address - Zip Code:44070
Practice Address - Country:US
Practice Address - Phone:440-779-9565
Practice Address - Fax:440-779-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0005085101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty