Provider Demographics
NPI:1699398388
Name:STELLASDREAM ART THERAPY & COUNSELING
Entity Type:Organization
Organization Name:STELLASDREAM ART THERAPY & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANEANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, LICDC-CS
Authorized Official - Phone:440-251-9325
Mailing Address - Street 1:8500 STATION ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4962
Mailing Address - Country:US
Mailing Address - Phone:440-251-9325
Mailing Address - Fax:440-549-0935
Practice Address - Street 1:8500 STATION ST STE 112
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4962
Practice Address - Country:US
Practice Address - Phone:440-251-9325
Practice Address - Fax:440-549-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty