1831799246 NPI number — SERENITY SPRINGS CLINICAL COUNSELING LLC

Table of content: (NPI 1831799246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831799246 NPI number — SERENITY SPRINGS CLINICAL COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY SPRINGS CLINICAL COUNSELING 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:
Provider Other Organization Name Type Code:
6
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:
1831799246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5913 PINEVILLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVE CITY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43123-2568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-537-7426
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 SALT MEADOW CIR UNIT 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34208-1772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-537-7426
Provider Business Practice Location Address Fax Number:
844-813-5222
Provider Enumeration Date:
10/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER/CLINICAL COUNSELOR
Authorized Official Telephone Number:
614-537-7426

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: 1073061149 . This is a "NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com