Jeffrey Kistler LPCC LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

JEFFREY KISTLER LPCC LLC

Practice address

1715 Indian Wood Cir Ste 200
Maumee, OH 43537-4055

Phone

(419) 740-8477

NPI assigned

Mar 14, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jeff Kistler, LPCC

Title

Managing Member

Phone

(419) 843-1370

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• FREEDOM FOUND COUNSELING SERVICE Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1114486628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7071 W CENTRAL AVE # 4",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436172700",
            "telephone_number": "419-843-1370",
            "fax_number": "419-754-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 INDIAN WOOD CIR STE 200",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435374055",
            "telephone_number": "419-740-8477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY KISTLER LPCC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-14",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "KISTLER",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "419-843-1370",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12277089",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FREEDOM FOUND COUNSELING SERVICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FREEDOM FOUND COUNSELING SERVICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Professional Counselor in Maumee, OH
• Providers in Maumee, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.