Healthcare Provider Details

I. General information

NPI: 1134770829
Provider Name (Legal Business Name): AKESO PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 S REYNOLDS RD STE B
TOLEDO OH
43615-7411
US

IV. Provider business mailing address

2372 WESTBANK RD
TOLEDO OH
43614-3174
US

V. Phone/Fax

Practice location:
  • Phone: 434-299-3673
  • Fax:
Mailing address:
  • Phone: 419-656-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS ERIN TAYLOR FOREMAN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 342-993-6734