Provider Demographics
NPI:1255150983
Name:JESSICA ARCHER THERAPY SERVICES
Entity type:Organization
Organization Name:JESSICA ARCHER THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:440-477-7195
Mailing Address - Street 1:1580 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7113
Mailing Address - Country:US
Mailing Address - Phone:440-477-7195
Mailing Address - Fax:
Practice Address - Street 1:1580 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7113
Practice Address - Country:US
Practice Address - Phone:440-477-7195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty