| Shalom Counseling & Mediation Center | |
|
22251 State Route 2 Archbold OH 43502-9452 | |
| (419) 445-1552 | |
| (419) 445-1401 |
| Full Name | Shalom Counseling & Mediation Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 22251 State Route 2, Archbold, Ohio |
| Authorized Official Name and Position | Jessica Bittner (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4194451552 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shalom Counseling & Mediation Center 22251 State Route 2 Archbold OH 43502-9452 Ph: (419) 445-1552 | Shalom Counseling & Mediation Center 22251 State Route 2 Archbold OH 43502-9452 Ph: (419) 445-1552 |
| NPI Number | 1366573552 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 11/05/2024 |
| Certification Date | 11/05/2024 |
| Medicare PECOS PAC ID | 7911376033 |
|---|---|
| Medicare Enrollment ID | O20221213001281 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366573552 | NPI | - | NPPES |
| 0423177 | Medicaid | OH | |
| 11648876 | Other | CAQH PROVIDER ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | I8483 (Ohio) | Primary |
| Provider Name | Lisa Ann Jewell Michael |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932182128 PECOS PAC ID: 0244245074 Enrollment ID: I20060215000047 |
| Provider Name | Kerry Beck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922271212 PECOS PAC ID: 7517336647 Enrollment ID: I20221213001495 |
| Provider Name | Richard Sherman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1467666099 PECOS PAC ID: 3476990102 Enrollment ID: I20240318001584 |
Lutheran Social Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: T-792 St Rt 66, Archbold, OH 43502 Phone: 419-267-5528 Fax: 419-267-5530 |