Provider Demographics
NPI:1477082857
Name:SARA RIDLEY COUNSELING PRACTICE, LLC
Entity Type:Organization
Organization Name:SARA RIDLEY COUNSELING PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-241-6054
Mailing Address - Street 1:1315 GRANGER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2232
Mailing Address - Country:US
Mailing Address - Phone:440-941-3285
Mailing Address - Fax:440-815-2189
Practice Address - Street 1:1315 GRANGER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-2232
Practice Address - Country:US
Practice Address - Phone:440-941-3285
Practice Address - Fax:440-815-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1000364261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099016Medicaid