Provider Demographics
NPI:1417506965
Name:SERENITY FAMILY AND INDIVIDUAL COUNSELING LLC
Entity Type:Organization
Organization Name:SERENITY FAMILY AND INDIVIDUAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:LAREE
Authorized Official - Last Name:BERIS
Authorized Official - Suffix:
Authorized Official - Credentials:IMFT, LPCC-S
Authorized Official - Phone:330-304-2387
Mailing Address - Street 1:180 HIGH ST STE D
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1874
Mailing Address - Country:US
Mailing Address - Phone:330-331-9203
Mailing Address - Fax:
Practice Address - Street 1:180 HIGH ST STE D
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1874
Practice Address - Country:US
Practice Address - Phone:330-331-9203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-07
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty