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MIAMI VALLEY COUNSELING, LLC
Complete NPI Record 1215204037
Counselor - Mental Health in Englewood, OH

NPI Status: Active since November 22, 2011

Contact Information

12 W WENGER RD
SUITE B-1
ENGLEWOOD, OH
ZIP 45322
Phone: (937) 836-4788
Fax: (937) 836-4799

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Second Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Provider License Number 1
  29. Provider License Number State Code 1
  30. Healthcare Provider Primary Taxonomy Switch 1
  31. Is Organization Subpart
  32. Authorized Official Name Prefix Text
  33. Authorized Official Credential Text
  34. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1215204037. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1215204037
The last name of the provider. If the provider is an individual, this is the legal name.
Entity Type Code: 2
The first name of the provider, if the provider is an individual.
Employer Identification Number EIN: UNAVAIL
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 12 W WENGER RD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE B-1
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: ENGLEWOOD
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OH
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 453222754
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 9378364788
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 9378364799
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 12 W WENGER RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE B-1
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: ENGLEWOOD
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OH
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 453222754
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 9378364788
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 9378364799
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 11/22/2011
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/22/2011
The date that a record was last updated or changed.
Authorized Official Last Name: BAINBRIDGE
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: SUSAN
The first name of the authorized official.
Authorized Official Title or Position: OWNER/OUTPATIENT THERAPIST
The title or position of the authorized official.
Authorized Official Telephone Number: 9378364788
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 101YM0800X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: E-3301
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: OH
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: MS.
Authorized Official Credential Text: LPCC
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP