Provider Demographics
NPI:1184420838
Name:ANNETTE HUMBERSON LISWS LLC
Entity type:Organization
Organization Name:ANNETTE HUMBERSON LISWS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUMBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISWS
Authorized Official - Phone:216-702-3868
Mailing Address - Street 1:9889 CLARIUS CIR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2939
Mailing Address - Country:US
Mailing Address - Phone:216-702-3868
Mailing Address - Fax:
Practice Address - Street 1:9889 CLARIUS CIR
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2939
Practice Address - Country:US
Practice Address - Phone:216-702-3868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty