Provider Demographics
| NPI: | 1205395605 |
|---|---|
| Name: | AZALEA INSTITUTE-CENTER FOR MFT & LPC ADVANCEMENT, LLC |
| Entity type: | Organization |
| Organization Name: | AZALEA INSTITUTE-CENTER FOR MFT & LPC ADVANCEMENT, LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT OF OPERATIONS/OWNER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | MEGAN |
| Authorized Official - Middle Name: | LYNN |
| Authorized Official - Last Name: | MIRANDA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | LPCC-S, IMFT-S, PHD |
| Authorized Official - Phone: | 330-510-4900 |
| Mailing Address - Street 1: | 421 GRAHAM RD STE B |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CUYAHOGA FALLS |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 44221-1344 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 330-510-4900 |
| Mailing Address - Fax: | 330-510-5900 |
| Practice Address - Street 1: | 421 GRAHAM RD STE B |
| Practice Address - Street 2: | |
| Practice Address - City: | CUYAHOGA FALLS |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 44221-1344 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 330-510-4900 |
| Practice Address - Fax: | 330-510-5900 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-03-14 |
| Last Update Date: | 2025-06-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 0255723 | Medicaid |
