Healthcare Provider Details

I. General information

NPI: 1356227821
Provider Name (Legal Business Name): AVA SIERRA VAZQUEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 W BAGLEY RD STE 13
BEREA OH
44017-1312
US

IV. Provider business mailing address

3840 WALNUT HOLLOW DR
MEDINA OH
44256-8447
US

V. Phone/Fax

Practice location:
  • Phone: 440-970-3790
  • Fax: 440-527-8043
Mailing address:
  • Phone: 330-734-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2608466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: