Healthcare Provider Details

I. General information

NPI: 1366928863
Provider Name (Legal Business Name): FAIRMOUNT MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4497 BIRCHWOLD RD
SOUTH EUCLID OH
44121-4215
US

IV. Provider business mailing address

4497 BIRCHWOLD RD
SOUTH EUCLID OH
44121-4215
US

V. Phone/Fax

Practice location:
  • Phone: 216-435-1235
  • Fax:
Mailing address:
  • Phone: 216-435-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1700425
License Number StateOH

VIII. Authorized Official

Name: MR. RICHARD DEMPSEY
Title or Position: THERAPIST/OWNER
Credential: LPCC
Phone: 216-435-1235