Healthcare Provider Details

I. General information

NPI: 1366097453
Provider Name (Legal Business Name): MELINDA GREENLAND LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 N JEFFERSON ST
MEDINA OH
44256-5639
US

IV. Provider business mailing address

PO BOX 72767
CLEVELAND OH
44192-0004
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-9615
  • Fax: 330-764-8795
Mailing address:
  • Phone: 800-860-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: