Healthcare Provider Details

I. General information

NPI: 1295244317
Provider Name (Legal Business Name): GROW WELL CLEVELAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5338 MEADOW LANE CT
SHEFFIELD VILLAGE OH
44035-1469
US

IV. Provider business mailing address

5338 MEADOW LANE CT
SHEFFIELD VILLAGE OH
44035-1469
US

V. Phone/Fax

Practice location:
  • Phone: 216-282-3838
  • Fax: 440-434-2011
Mailing address:
  • Phone: 216-282-3838
  • Fax: 440-434-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLE YOUNG
Title or Position: BILLING MANAGER
Credential:
Phone: 440-654-3424