Healthcare Provider Details

I. General information

NPI: 1932770526
Provider Name (Legal Business Name): HANNAH MATHIES LICDC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 BROADWAY AVE
CLEVELAND OH
44125-1957
US

IV. Provider business mailing address

14445 BROADWAY AVE
CLEVELAND OH
44125-1957
US

V. Phone/Fax

Practice location:
  • Phone: 216-677-8177
  • Fax:
Mailing address:
  • Phone: 216-677-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162469
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2305465
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: