Provider Demographics
NPI:1801420880
Name:WINDING ROAD THERAPY GROUP LLC
Entity type:Organization
Organization Name:WINDING ROAD THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:RASTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:330-861-6682
Mailing Address - Street 1:4687 LABURNUM DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-4520
Mailing Address - Country:US
Mailing Address - Phone:330-861-6682
Mailing Address - Fax:
Practice Address - Street 1:4687 LABURNUM DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-4520
Practice Address - Country:US
Practice Address - Phone:330-861-6682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty