1346780137 NPI number — FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346780137 NPI number — FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346780137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3926 CLOCK POINTE TRL
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
STOW
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44224-6965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-529-2002
Provider Business Mailing Address Fax Number:
330-529-2002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 TALL GRASS CIR
Provider Second Line Business Practice Location Address:
#202
Provider Business Practice Location Address City Name:
STOW
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44224-6936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-280-0716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GIOVANNELLI
Authorized Official First Name:
LISA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-280-0716

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  011296 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: E0800007SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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