Sacred Space Christian Counseling LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SACRED SPACE CHRISTIAN COUNSELING LLC

Practice address

1150 N Ottokee St
Wauseon, OH 43567-1912

Phone

(419) 330-4141

Fax

(419) 330-4171

NPI assigned

Jun 20, 2025

Last updated

Jun 20, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jean Wagner, LSW, LPCC-SNPI 1326487679

Title

Owner

Phone

(419) 438-6465

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jean L. Wagner, LPCC

  • Professional Counselor
  • Bryan, OH
  • NPI 1326487679
  NPD Authorized official

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

{
    "created_epoch": "1750377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750377600000",
    "number": "1801783063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13361 COUNTY ROAD C2",
            "city": "HOLGATE",
            "state": "OH",
            "postal_code": "435279628",
            "telephone_number": "419-438-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N OTTOKEE ST",
            "city": "WAUSEON",
            "state": "OH",
            "postal_code": "435671912",
            "telephone_number": "419-330-4141",
            "fax_number": "419-330-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED SPACE CHRISTIAN COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-20",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-438-6465",
        "authorized_official_credential": "LSW, LPCC-S"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Graber Roth, DDS
• Roberta Roth
• Todd Rusho
• April May Russell
• Heather Russell
• Sara's Garden-the Sara Joy Rychener-Burkholder Hyperbaric Center
• Justin M Sauder, CRNA
• Paige Alexandria Schantz
• Lisette Schuette
• Jessica Schultheis

• Mental Health Counselor in Wauseon, OH
• Providers in Wauseon, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2025; 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.