=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114712189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ARIEL DE'FREEZE COUNSELING COLLECTIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2025
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2490 LEE BLVD
-----------------------------------------------------
City | CLEVELAND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-1268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-474-0028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 181223
-----------------------------------------------------
City | CLEVELAND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-7223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-474-0028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ARIEL DE'FREEZE
-----------------------------------------------------
Credential | LISW-S
-----------------------------------------------------
Telephone | 216-256-1214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------