Healthcare Provider Details

I. General information

NPI: 1649186792
Provider Name (Legal Business Name): THRESHOLD THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 CLOCK POINTE TRL STE 105
STOW OH
44224-2989
US

IV. Provider business mailing address

3918 CLOCK POINTE TRL STE 105
STOW OH
44224-2989
US

V. Phone/Fax

Practice location:
  • Phone: 760-593-8011
  • Fax:
Mailing address:
  • Phone: 760-593-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW L NELSON
Title or Position: OWNER
Credential: LISW, LICDC
Phone: 760-593-8011