Healthcare Provider Details

I. General information

NPI: 1457726762
Provider Name (Legal Business Name): ANNA TYRRELL M.ED., LSW, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 PLUM ST.
FAIRPORT HARBOR OH
44077
US

IV. Provider business mailing address

PO BOX 1141
MENTOR OH
44061-1141
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-1214
  • Fax:
Mailing address:
  • Phone: 440-476-2958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2505307
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505307
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: