Provider Demographics
NPI: | 1962893479 |
---|---|
Name: | KLS COUNSELING LLC |
Entity type: | Organization |
Organization Name: | KLS COUNSELING LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KRISTIN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SEIL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPCC |
Authorized Official - Phone: | 216-534-9601 |
Mailing Address - Street 1: | 1644 BOBWHITE TRL |
Mailing Address - Street 2: | |
Mailing Address - City: | STOW |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44224-2509 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 440-461-1255 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5564 WILSON MILLS RD |
Practice Address - Street 2: | SUITE 201 |
Practice Address - City: | HIGHLAND HEIGHTS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44143-3265 |
Practice Address - Country: | US |
Practice Address - Phone: | 440-461-1255 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-02-05 |
Last Update Date: | 2015-03-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | E.1000628 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |