Healthcare Provider Details

I. General information

NPI: 1134058829
Provider Name (Legal Business Name): OPEN DOOR COUNSELING & COMMUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 4TH ST
ELYRIA OH
44035-5771
US

IV. Provider business mailing address

300 4TH ST
ELYRIA OH
44035-5771
US

V. Phone/Fax

Practice location:
  • Phone: 440-667-5480
  • Fax:
Mailing address:
  • Phone: 440-667-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH BROADDUS
Title or Position: EXECUTIVE DIRECTOR
Credential: LPCC-S
Phone: 440-667-5480