Healthcare Provider Details

I. General information

NPI: 1679699573
Provider Name (Legal Business Name): NORTHEAST OHIO BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 PORTAGE ST NW SUITE 103
NORTH CANTON OH
44720-7371
US

IV. Provider business mailing address

2795 FRONT ST SUITE A
CUYAHOGA FALLS OH
44221-1900
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-5155
  • Fax: 330-494-6868
Mailing address:
  • Phone: 330-945-7100
  • Fax: 330-945-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0483
License Number StateOH

VIII. Authorized Official

Name: DR. ROBIN R. TENER
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 330-945-7100