Healthcare Provider Details

I. General information

NPI: 1306768387
Provider Name (Legal Business Name): HOUSE OF SHALOM THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 SUNFOREST CT STE 265
TOLEDO OH
43623-4485
US

IV. Provider business mailing address

22 SOUTHARD UNIT E
TOLEDO OH
43604
US

V. Phone/Fax

Practice location:
  • Phone: 419-407-6092
  • Fax: 419-839-2925
Mailing address:
  • Phone: 419-280-6059
  • Fax: 419-839-2925

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: LEVARINE GRAHAM
Title or Position: OWNER/THERAPIST
Credential: LISW
Phone: 419-280-6059