Healthcare Provider Details

I. General information

NPI: 1558291336
Provider Name (Legal Business Name): SELF-ESTEAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WENZ RD
TOLEDO OH
43615-6244
US

IV. Provider business mailing address

4285 KEYGATE DR APT 306
TOLEDO OH
43614-4890
US

V. Phone/Fax

Practice location:
  • Phone: 419-377-5693
  • Fax:
Mailing address:
  • Phone: 419-377-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SADORA MONTGOMERY
Title or Position: DIRECTOR
Credential:
Phone: 419-377-5693