Provider Demographics
NPI:1003307810
Name:LENZY FAMILY INSTITUTE
Entity Type:Organization
Organization Name:LENZY FAMILY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LENZY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:330-956-5936
Mailing Address - Street 1:1930 FULTON RD NW STE 103
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3526
Mailing Address - Country:US
Mailing Address - Phone:330-956-5936
Mailing Address - Fax:
Practice Address - Street 1:1930 FULTON RD NW STE 103
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3526
Practice Address - Country:US
Practice Address - Phone:330-956-5936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0001362261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054717Medicaid