Provider Demographics
NPI:1346780137
Name:FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC
Entity Type:Organization
Organization Name:FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIOVANNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-280-0716
Mailing Address - Street 1:3926 CLOCK POINTE TRL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6965
Mailing Address - Country:US
Mailing Address - Phone:330-529-2002
Mailing Address - Fax:330-529-2002
Practice Address - Street 1:1145 TALL GRASS CIR
Practice Address - Street 2:#202
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6936
Practice Address - Country:US
Practice Address - Phone:330-280-0716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0800007SUPV101Y00000X
OH011296101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty