Healthcare Provider Details

I. General information

NPI: 1831172576
Provider Name (Legal Business Name): CHILD AND ADOLESCENT BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
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 TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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