Healthcare Provider Details

I. General information

NPI: 1831772813
Provider Name (Legal Business Name): JOSEPH OMBRELLO JR. M.ED. LCPC, LIAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BURNING OAKS DR NE
WARREN OH
44484-2104
US

IV. Provider business mailing address

600 BURNING OAKS DR NE
WARREN OH
44484-2104
US

V. Phone/Fax

Practice location:
  • Phone: 480-482-0309
  • Fax:
Mailing address:
  • Phone: 480-482-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLIAC15416
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0023158
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162703
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505841
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-81381
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: