Healthcare Provider Details

I. General information

NPI: 1023566270
Provider Name (Legal Business Name): SARA ANN TREMBATH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8351 MENTOR AVE
MENTOR OH
44060-5749
US

IV. Provider business mailing address

529 E MAIN ST APT 12B
RAVENNA OH
44266-3263
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-2273
  • Fax: 216-896-0735
Mailing address:
  • Phone: 330-281-7786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2001948
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001948
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC 1600469
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: