Provider Demographics
NPI:1083172530
Name:SIMPLY AMAZING FAMILY ENVIRONMENT
Entity Type:Organization
Organization Name:SIMPLY AMAZING FAMILY ENVIRONMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEREENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREAMER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:330-328-8558
Mailing Address - Street 1:10154 RIDGEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-6602
Mailing Address - Country:US
Mailing Address - Phone:330-328-8558
Mailing Address - Fax:
Practice Address - Street 1:935 FROST RD
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4840
Practice Address - Country:US
Practice Address - Phone:330-328-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0284690Medicaid