Provider Demographics
NPI:1538846902
Name:BROOK RUN COUNSELING & CONSULTING, LLC
Entity type:Organization
Organization Name:BROOK RUN COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:419-632-0588
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44862-0102
Mailing Address - Country:US
Mailing Address - Phone:419-632-0588
Mailing Address - Fax:888-522-4535
Practice Address - Street 1:3666 PARK AVE W
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44903-9107
Practice Address - Country:US
Practice Address - Phone:419-632-0588
Practice Address - Fax:888-522-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty