| Organization Name: | COVENANT INTEGRATIVE COUNSELING SERVICES, LLC |
| NPI Number: | 1366864936 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY ANN JEPSEN (OWNER) |
| Mailing Address: | 9633 E State Route 37 Sunbury |
| State: | OH US |
| Postal Code: | 430749672 |
| Phone Number: | 6143092270 |
| Fax Number: | 6144366884 |
| NPI Enumeration Date: | 01/15/2014 |
| NPI Last Update Date: | 01/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | E0700010 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |