Healthcare Provider Details

I. General information

NPI: 1821577131
Provider Name (Legal Business Name): CHILD AND ADOLESCENT BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 FULTON DR NW
CANTON OH
44718-2384
US

IV. Provider business mailing address

4641 FULTON DR NW
CANTON OH
44718-2384
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-6075
  • Fax: 330-494-0299
Mailing address:
  • Phone: 330-433-6075
  • Fax: 330-494-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY SHAHAN
Title or Position: HR ADMIN ASST/CREDENTIALING
Credential:
Phone: 330-433-6075