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General NPI Number Information
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NPI Number | 1043569866
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Entity Type | Organization
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Legal Business Name | A SAFE PLACE MENTAL HEALTH COUNSELING SERVICES
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 30841 EUCLID AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094-3100
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Country | US
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Telephone | 440-516-0281
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Fax | 440-516-0281
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Provider Business Mailing Address
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Address Line | 30841 EUCLID AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094-3100
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Country | US
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Telephone | 440-516-0281
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Fax | 440-516-0281
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIMBERLY ANN ANDREWS
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Credential | PC
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Telephone | 216-310-8471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 0600269
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0600269
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License Number State | OH
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