Provident Clinical Counseling

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

I1600187 Issued in OH

Legal business name

PROVIDENT CLINICAL COUNSELING

Practice address

232 N Market St
Galion, OH 44833-1920

Phone

(567) 393-9693

NPI assigned

Sep 26, 2016

Last updated

Sep 26, 2016By 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

Ms. Rachel Lucki, LISW

Title

Director

Phone

(567) 393-9693

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1912456476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 N MARKET ST",
            "city": "GALION",
            "state": "OH",
            "postal_code": "448331920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 N MARKET ST",
            "city": "GALION",
            "state": "OH",
            "postal_code": "448331920",
            "telephone_number": "567-393-9693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT CLINICAL COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-26",
        "last_updated": "2016-09-26",
        "status": "A",
        "authorized_official_last_name": "LUCKI",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "567-393-9693",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OH",
            "license": "I1600187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; 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.