Healthcare Provider Details

I. General information

NPI: 1578276747
Provider Name (Legal Business Name): CUYAHOGA VALLEY MINDFUL HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26463 SOLON RD APT 511
OAKWOOD VILLAGE OH
44146-4733
US

IV. Provider business mailing address

30701 LORAIN RD STE A
NORTH OLMSTED OH
44070-6325
US

V. Phone/Fax

Practice location:
  • Phone: 330-803-3420
  • Fax:
Mailing address:
  • Phone: 440-274-5035
  • Fax: 440-716-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERIC RIESTERER
Title or Position: OWNER
Credential: LPC
Phone: 330-621-5807