Healthcare Provider Details

I. General information

NPI: 1801510821
Provider Name (Legal Business Name): JMINI THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34461 S SIDE PARK DR
SOLON OH
44139-4925
US

IV. Provider business mailing address

34461 S SIDE PARK DR
SOLON OH
44139-4925
US

V. Phone/Fax

Practice location:
  • Phone: 440-325-0059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAMES MINIKOWSKI
Title or Position: OWNER
Credential: LCSW
Phone: 440-325-0059