Healthcare Provider Details

I. General information

NPI: 1770990954
Provider Name (Legal Business Name): ANGELA LETZNER LPCCS-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2014
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W LIBERTY ST
MEDINA OH
44256-2219
US

IV. Provider business mailing address

20525 CENTER RIDGE RD STE 365
ROCKY RIVER OH
44116-3440
US

V. Phone/Fax

Practice location:
  • Phone: 866-466-9591
  • Fax: 216-712-6313
Mailing address:
  • Phone: 866-466-9591
  • Fax: 216-712-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1300565-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: