Healthcare Provider Details

I. General information

NPI: 1174094189
Provider Name (Legal Business Name): LET'S GET REAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 OBERLIN AVE
LORAIN OH
44052-3959
US

IV. Provider business mailing address

1939 OBERLIN AVE
LORAIN OH
44052-3959
US

V. Phone/Fax

Practice location:
  • Phone: 440-963-7042
  • Fax: 440-963-9248
Mailing address:
  • Phone: 440-963-7042
  • Fax: 440-963-9248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY EBERLE
Title or Position: ORGANIZATION DIRECTOR
Credential: LSW, LCDC III
Phone: 440-963-7042