Provider Demographics
NPI:1962770529
Name:FERENS, CHRISTINE (MED, PCC,NCC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:FERENS
Suffix:
Gender:F
Credentials:MED, PCC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 LAMME RD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-3215
Mailing Address - Country:US
Mailing Address - Phone:937-534-4651
Mailing Address - Fax:937-534-4669
Practice Address - Street 1:5348 LAMME RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-3215
Practice Address - Country:US
Practice Address - Phone:937-534-4651
Practice Address - Fax:937-534-4669
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003011101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE0003011OtherOHIO PROF CLINICAL COUNSELOR