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General NPI Number Information
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NPI Number | 1255150983
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Entity Type | Organization
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Legal Business Name | JESSICA ARCHER THERAPY SERVICES
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1580 PROSPECT ST
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City | ELYRIA
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State | OH
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Zip | 44035-7113
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Country | US
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Telephone | 440-477-7195
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 PROSPECT ST
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City | ELYRIA
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State | OH
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Zip | 44035-7113
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Country | US
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Telephone | 440-477-7195
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JESSICA ARCHER
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Credential | LISW-S
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Telephone | 440-477-7195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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