Healthcare Provider Details

I. General information

NPI: 1568349959
Provider Name (Legal Business Name): AXIS MENTAL HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 S UNION AVE
ALLIANCE OH
44601-4349
US

IV. Provider business mailing address

1610 S UNION AVE
ALLIANCE OH
44601-4349
US

V. Phone/Fax

Practice location:
  • Phone: 330-356-8256
  • Fax:
Mailing address:
  • Phone: 330-356-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JIM LAUGHLIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-356-8256