Provider Demographics
NPI:1972150761
Name:EISH, JENNY (LPCC, R-DMT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:EISH
Suffix:
Gender:
Credentials:LPCC, R-DMT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:EISH-BALTAOGLU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9740 TAYLOR MAY RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-2421
Mailing Address - Country:US
Mailing Address - Phone:917-780-8809
Mailing Address - Fax:
Practice Address - Street 1:516 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-4402
Practice Address - Country:US
Practice Address - Phone:440-769-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-2505164101YP2500X
OHC.1901920-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty