UPI (Provider ID): 10056
Change Report (if Any):

Short Name: COUNSEL SOURCE

Long Name 1: THE COUNSELING SOURCE INC
Long Name 2:

Address 1: 10921 REED HARTMAN HIGHWAY
Address 2: SUITE 133

City: CINCINNATI
Zip Code: 45242
County: HAMI

Contact: DAVID TURNER
Title: EX DR
Phone: 5139849838
FAX: 5139848075

Vendor: 10056

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012