Healthcare Provider Details

I. General information

NPI: 1285207704
Provider Name (Legal Business Name): 2INSPIRE BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 STATE ROUTE 43 STE 210
STREETSBORO OH
44241-5367
US

IV. Provider business mailing address

9453 VISTA CT
STREETSBORO OH
44241-3601
US

V. Phone/Fax

Practice location:
  • Phone: 330-968-5976
  • Fax:
Mailing address:
  • Phone: 330-541-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SERITA J EILAND
Title or Position: OWNER
Credential: LPC
Phone: 330-541-3207