Healthcare Provider Details

I. General information

NPI: 1548114515
Provider Name (Legal Business Name): EPICENE PSYCHOLOGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12765 VINCENT DR
MANTUA OH
44255-9309
US

IV. Provider business mailing address

12765 VINCENT DR
MANTUA OH
44255-9309
US

V. Phone/Fax

Practice location:
  • Phone: 216-644-6334
  • Fax:
Mailing address:
  • Phone: 216-644-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: PAUL LACHER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCDC
Phone: 216-644-6334