NPIMap

Organization Active NPI

Counseling Center of Wayne & Holmes Counties

  • Community/Behavioral Health Agency
  • Wooster, OH
National Provider Identifier
1215975685
Registry record updated Feb 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COUNSELING CENTER OF WAYNE & HOLMES COUNTIES
Practice address
2285 Benden Dr
Wooster, OH 44691-2568
Phone
(330) 264-9029
Fax
(330) 263-7251
NPI assigned
Jun 4, 2006
Organization subpart
Yes
Parent organization
SOURCEONE BEHAVIORAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 18, 2019

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

Authorized official

Name
Dr. Karen D. Berry, PSY.D.
Title
President/Ceo
Phone
(330) 264-9029

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X OH Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

2285 Benden Dr
Wooster, OH 44691-2568

Mailing address

2285 Benden Dr
Wooster, OH 44691-2568
Phone (330) 264-9029

Other identifiers 4

IdentifierTypeStateIssuer
10038OtherOHODMH - MACSIS
0200213OtherOHMEDICAID/MEDICARE CROSSOV
MC5101MedicaidOH
2372543MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040511000614 OH Part B Supplier - Clinic/Group Practice 5991794224 Receives reassigned benefits from 20 practitioners
Practice locations: Millersburg, OH; Orrville, OH; Rittman, OH; Wadsworth, OH; Wooster, OH

National Provider Directory

National Provider Directory
Tax ID family
Counseling Center of Wayne2 organizations share this tax ID, including this one
Part of
Sourceone Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

859 S Main St
Orrville, OH 44667
Phone (330) 682-1276

8 N Main St
Rittman, OH 44270
Phone (330) 925-5466

22 W Ohio Ave
Rittman, OH 44270
Phone (330) 925-5466

8598 Hartman Rd
Wadsworth, OH 44281
Phone (234) 217-8589

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550448000000",
    "number": "1215975685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 BENDEN DR",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912568",
            "telephone_number": "330-264-9029",
            "fax_number": "330-263-7251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2285 BENDEN DR",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912568",
            "telephone_number": "330-264-9029",
            "fax_number": "330-263-7251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNSELING CENTER OF WAYNE & HOLMES COUNTIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOURCEONE BEHAVIORAL HEALTH",
        "enumeration_date": "2006-06-04",
        "last_updated": "2019-02-18",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "330-264-9029",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OH",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ODMH - MACSIS",
            "identifier": "10038",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID/MEDICARE CROSSOV",
            "identifier": "0200213",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MC5101",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2372543",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.