1558872697 NPI number — VESSELS COUNSELING CONSULTANTS LLC

Table of content: (NPI 1558872697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558872697 NPI number — VESSELS COUNSELING CONSULTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VESSELS COUNSELING CONSULTANTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TASHEA CAMPBELL, LPCCS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558872697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 W MAIN ST UNIT 902
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ALBANY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43054-9191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-383-8375
Provider Business Mailing Address Fax Number:
614-983-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 W MAIN ST UNIT 902
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43054-9191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-383-8375
Provider Business Practice Location Address Fax Number:
614-983-1106
Provider Enumeration Date:
10/16/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAMPBELL, LPCCS
Authorized Official First Name:
TASHEA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
614-981-9982

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0013330 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".