Healthcare Provider Details

I. General information

NPI: 1982118766
Provider Name (Legal Business Name): LENA SIMONE HARRIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7519 MENTOR AVE STE 114
MENTOR OH
44060-5410
US

IV. Provider business mailing address

7519 MENTOR AVE STE 114
MENTOR OH
44060-5410
US

V. Phone/Fax

Practice location:
  • Phone: 440-701-6170
  • Fax: 440-527-8043
Mailing address:
  • Phone: 440-701-6170
  • Fax: 440-527-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1801143
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: