Healthcare Provider Details

I. General information

NPI: 1336822824
Provider Name (Legal Business Name): HOPE INSTITUTE OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 COMMERCE DR BLDG 1, STE 101
PERRYSBURG OH
43551-5231
US

IV. Provider business mailing address

1070 COMMERCE DRIVE BUILDING ONE, SUITE 101
PERRYSBURG OH
43551-5231
US

V. Phone/Fax

Practice location:
  • Phone: 419-482-8382
  • Fax:
Mailing address:
  • Phone: 419-482-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. DEREK J LEE
Title or Position: CEO
Credential: LPCC-S
Phone: 419-290-4722