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1306768387 NPI number — HOUSE OF SHALOM THERAPEUTIC SERVICES, LLC

NPI Number: 1306768387
Health Care Provider/Practitioner: HOUSE OF SHALOM THERAPEUTIC SERVICES, LLC

Information about “1306768387” NPI (HOUSE OF SHALOM THERAPEUTIC SERVICES, LLC) exists in 1306768387 in HTML format HTML  |  1306768387 in plain Text format TXT  |  1306768387 in PDF (Portable Document Format) PDF  |  1306768387 in an XML format XML  formats.

NPI Number : 1306768387 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306768387",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "HOUSE OF SHALOM THERAPEUTIC SERVICES, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "22 SOUTHARD",
    "SecondLineMailingAddress": "UNIT E",
    "MailingAddressCityName": "TOLEDO",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "43604",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "419-280-6059",
    "MailingAddressFaxNumber": "419-839-2925",
    "FirstLinePracticeLocationAddress": "22 SOUTHARD",
    "SecondLinePracticeLocationAddress": "UNIT E",
    "PracticeLocationAddressCityName": "TOLEDO",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "43604",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "419-280-6059",
    "PracticeLocationAddressFaxNumber": "419-839-2925",
    "EnumerationDate": "07/29/2026",
    "LastUpdateDate": "07/29/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GRAHAM",
    "AuthorizedOfficialFirstName": "LEVARINE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER/THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LISW",
    "AuthorizedOfficialTelephoneNumber": "419-280-6059",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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