Healthcare Provider Details

I. General information

NPI: 1508778929
Provider Name (Legal Business Name): TIMESHERVEDRECOVERYLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 3RD ST SW
WARREN OH
44483-6421
US

IV. Provider business mailing address

629 3RD ST SW
WARREN OH
44483-6421
US

V. Phone/Fax

Practice location:
  • Phone: 330-984-1108
  • Fax:
Mailing address:
  • Phone: 330-984-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: BRYAN LYTON
Title or Position: CLINICAL DIRECTOR
Credential: LCDC 2
Phone: 330-842-1788