Healthcare Provider Details

I. General information

NPI: 1760201461
Provider Name (Legal Business Name): BENEVOLENT THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 OAK ALLEY CT STE 214
TOLEDO OH
43606-1370
US

IV. Provider business mailing address

3454 OAK ALLEY CT STE 214
TOLEDO OH
43606-1370
US

V. Phone/Fax

Practice location:
  • Phone: 419-740-1836
  • Fax:
Mailing address:
  • Phone: 419-740-1836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA JAMBOR
Title or Position: OWNER
Credential: LISW
Phone: 419-341-8728