Healthcare Provider Details

I. General information

NPI: 1346732096
Provider Name (Legal Business Name): EDWARD L LENZY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3757 CLEVELAND AVE NW STE 206
CANTON OH
44709-2374
US

IV. Provider business mailing address

3757 CLEVELAND AVE NW STE 206
CANTON OH
44709-2374
US

V. Phone/Fax

Practice location:
  • Phone: 330-681-6646
  • Fax: 330-681-6368
Mailing address:
  • Phone: 330-681-6646
  • Fax: 330-681-6368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number187579
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: