Healthcare Provider Details

I. General information

NPI: 1942163860
Provider Name (Legal Business Name): INTELLECTUALS HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 LEWIS AVE
TOLEDO OH
43612-1846
US

IV. Provider business mailing address

4410 LEWIS AVE
TOLEDO OH
43612-1846
US

V. Phone/Fax

Practice location:
  • Phone: 419-514-4265
  • Fax: 419-725-0001
Mailing address:
  • Phone: 419-514-4265
  • Fax: 419-725-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHADAMA HOWARD
Title or Position: OWNER
Credential:
Phone: 419-514-4265