| Organization Name: | CONSORTIUM CLINICAL SERVICES, LLC |
| NPI Number: | 1417206954 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEITH VUKASINOVICH (PRESIDENT) |
| Mailing Address: | 2580 Shiloh Springs Rd Suite A Trotwood |
| State: | OH US |
| Postal Code: | 454262151 |
| Phone Number: | 8884400982 |
| Fax Number: | 8666611991 |
| NPI Enumeration Date: | 08/30/2012 |
| NPI Last Update Date: | 08/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |