Provider Demographics
NPI:1972793552
Name:JMAC COUNSELING SERVICES
Entity type:Organization
Organization Name:JMAC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCCLUER
Authorized Official - Suffix:
Authorized Official - Credentials:PCC
Authorized Official - Phone:937-427-9151
Mailing Address - Street 1:1374 N FAIRFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2676
Mailing Address - Country:US
Mailing Address - Phone:937-427-9151
Mailing Address - Fax:937-429-9942
Practice Address - Street 1:1374 N FAIRFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2676
Practice Address - Country:US
Practice Address - Phone:937-427-9151
Practice Address - Fax:937-429-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2785251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health