Provider Demographics
NPI: | 1700200805 |
---|---|
Name: | LIVING TREE COUNSELING |
Entity Type: | Organization |
Organization Name: | LIVING TREE COUNSELING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGING DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRIAN |
Authorized Official - Middle Name: | TODD |
Authorized Official - Last Name: | STRAWN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MPA |
Authorized Official - Phone: | 330-575-5300 |
Mailing Address - Street 1: | 2701 CLEVELAND AVE NW |
Mailing Address - Street 2: | |
Mailing Address - City: | CANTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44709-3362 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-575-5300 |
Mailing Address - Fax: | 866-823-0744 |
Practice Address - Street 1: | 2701 CLEVELAND AVE NW |
Practice Address - Street 2: | |
Practice Address - City: | CANTON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44709-3362 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-575-5300 |
Practice Address - Fax: | 866-823-0744 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-02-10 |
Last Update Date: | 2014-02-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | E0601018 | 251S00000X |
OH | LCDC0812793 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |