Healthcare Provider Details

I. General information

NPI: 1285495382
Provider Name (Legal Business Name): ESTRELLAASIA CIPTAK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 FULTON DR NW
CANTON OH
44718-2332
US

IV. Provider business mailing address

4522 FULTON DR NW
CANTON OH
44718-2332
US

V. Phone/Fax

Practice location:
  • Phone: 330-915-2907
  • Fax: 330-915-2958
Mailing address:
  • Phone: 330-915-2907
  • Fax: 330-915-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2405486-TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2506804
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: