Organization
COUNSELING CENTER OF WAYNE & HOLMES COUNTIES
Active
Parent organization
SOURCEONE BEHAVIORAL HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOURCEONE BEHAVIORAL HEALTH
Authorized official
DR. KAREN D. BERRY PSY.D. (PRESIDENT/CEO)
(330) 264-9029
Entity
Organization
Contact information
Practice address
2285 BENDEN DR, WOOSTER, OH 44691-2568
(330) 264-9029
(330) 263-7251
Mailing address
2285 BENDEN DR, WOOSTER, OH 44691-2568
(330) 264-9029
(330) 263-7251
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
OH
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0200213
MEDICAID/MEDICARE CROSSOV
OH
01
—
10038
ODMH - MACSIS
OH
05
—
2372543
—
OH
05
—
MC5101
—
OH
Enumeration date
06/04/2006
Last updated
02/18/2019
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