Provider Demographics
NPI:1902360977
Name:CLEVELAND COUNSELING CENTER
Entity Type:Organization
Organization Name:CLEVELAND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, IMFT-S, LPC
Authorized Official - Phone:216-533-6330
Mailing Address - Street 1:23360 CHAGRIN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5537
Mailing Address - Country:US
Mailing Address - Phone:216-533-6330
Mailing Address - Fax:
Practice Address - Street 1:23360 CHAGRIN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5537
Practice Address - Country:US
Practice Address - Phone:216-533-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty