| Neo Counseling Services, Llc | |
|
9930 Johnnycake Ridge Rd Ste 4f Mentor OH 44060-6762 | |
| (440) 579-5100 | |
| (440) 579-5104 |
| Full Name | Neo Counseling Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 9930 Johnnycake Ridge Rd Ste 4f, Mentor, Ohio |
| Authorized Official Name and Position | Katie Marchinchin (OWNER) |
| Authorized Official Contact | 4045278006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neo Counseling Services, Llc 9930 Johnnycake Ridge Rd Ste 4f Mentor OH 44060-6762 Ph: (440) 579-5100 | Neo Counseling Services, Llc 9930 Johnnycake Ridge Rd Ste 4f Mentor OH 44060-6762 Ph: (440) 579-5100 |
| NPI Number | 1528421252 |
|---|---|
| Provider Enumeration Date | 03/31/2016 |
| Last Update Date | 03/23/2023 |
| Certification Date | 03/23/2023 |
| Medicare PECOS PAC ID | 8224401898 |
|---|---|
| Medicare Enrollment ID | O20230301001365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528421252 | NPI | - | NPPES |
| 0208743 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | E1000347 (Ohio) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Nicole Kelleher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326552183 PECOS PAC ID: 1759746084 Enrollment ID: I20230420001136 |
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