Provider Demographics
NPI:1336901842
Name:THE FERN BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:THE FERN BEHAVIORAL HEALTH, LLC
Other - Org Name:THE FERN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:773-920-8675
Mailing Address - Street 1:3075 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2514
Mailing Address - Country:US
Mailing Address - Phone:567-588-0220
Mailing Address - Fax:
Practice Address - Street 1:3075 W ELM ST STE A
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2514
Practice Address - Country:US
Practice Address - Phone:567-588-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health