Healthcare Provider Details

I. General information

NPI: 1144178922
Provider Name (Legal Business Name): CHAGRIN RIVER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6295 CHAGRIN RIVER RD
CHAGRIN FALLS OH
44022-3544
US

IV. Provider business mailing address

17216 WOOD ACRE TRL
CHAGRIN FALLS OH
44023-2732
US

V. Phone/Fax

Practice location:
  • Phone: 216-509-9011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LISA KIRBY
Title or Position: COUNSELOR
Credential: LPCC-S, IMFT
Phone: 216-509-9011