Healthcare Provider Details

I. General information

NPI: 1497617252
Provider Name (Legal Business Name): HALDEN PSYCHOTHERAPY AND CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 LAUREL GLENS DR
MEDINA OH
44256-2743
US

IV. Provider business mailing address

885 LAUREL GLENS DR
MEDINA OH
44256-2743
US

V. Phone/Fax

Practice location:
  • Phone: 216-536-6924
  • Fax:
Mailing address:
  • Phone: 216-536-6924
  • 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: LOGAN JOHNSON
Title or Position: CLINICAL DIRECTOR
Credential: MA, LPCC-S
Phone: 216-536-6924