Provider Demographics
NPI:1477178846
Name:SMALL BEHAVIORAL HEALTH COUNSELING
Entity Type:Organization
Organization Name:SMALL BEHAVIORAL HEALTH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAKIYAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:330-338-1308
Mailing Address - Street 1:2556 DURAND RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3835
Mailing Address - Country:US
Mailing Address - Phone:330-338-1308
Mailing Address - Fax:
Practice Address - Street 1:1213 COVENTRY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2229
Practice Address - Country:US
Practice Address - Phone:330-460-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health