Healthcare Provider Details

I. General information

NPI: 1235113697
Provider Name (Legal Business Name): WILLIAM SCOTT VEENSTRA LISW, LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8351 MENTOR AVE
MENTOR OH
44060-5749
US

IV. Provider business mailing address

PO BOX 24242
CLEVELAND OH
44124-0242
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-2273
  • Fax: 216-896-0735
Mailing address:
  • Phone: 216-839-2273
  • Fax: 216-896-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number852101
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI0004195
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: