Provider Demographics
NPI:1801392238
Name:SQUARE ONE COUNSELING AND PSYCHOTHERAPY
Entity Type:Organization
Organization Name:SQUARE ONE COUNSELING AND PSYCHOTHERAPY
Other - Org Name:CHAVA HARRIS
Other - Org Type:Other Name
Authorized Official - Title/Position:SOCIAL WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAVA
Authorized Official - Middle Name:EMMA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:216-970-0732
Mailing Address - Street 1:PO BOX 221261
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0996
Mailing Address - Country:US
Mailing Address - Phone:216-970-0732
Mailing Address - Fax:216-274-9007
Practice Address - Street 1:2460 FAIRMOUNT BLVD STE 320
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3164
Practice Address - Country:US
Practice Address - Phone:216-970-0732
Practice Address - Fax:216-274-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1000021-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty