Provider Demographics
NPI:1063987287
Name:FIRELANDS COUNSELING AND RECOVERY SERVICES
Entity type:Organization
Organization Name:FIRELANDS COUNSELING AND RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST II
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEYATT-MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:S1701072
Authorized Official - Phone:440-984-3882
Mailing Address - Street 1:1925 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4737
Mailing Address - Country:US
Mailing Address - Phone:419-557-5211
Mailing Address - Fax:
Practice Address - Street 1:1925 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4737
Practice Address - Country:US
Practice Address - Phone:419-557-5211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101Y00000XMedicaid