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General NPI Number Information
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NPI Number | 1366928863
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Entity Type | Organization
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Legal Business Name | FAIRMOUNT MENTAL WELLNESS LLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 2460 FAIRMOUNT BLVD STE 317
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City | CLEVELAND HEIGHTS
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State | OH
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Zip | 44106-3164
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Country | US
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Telephone | 216-714-2910
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Fax |
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Provider Business Mailing Address
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Address Line | 2460 FAIRMOUNT BLVD STE 317
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City | CLEVELAND HEIGHTS
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State | OH
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Zip | 44106-3164
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Country | US
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Telephone | 216-714-2910
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | MR. RICHARD DEMPSEY
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Credential | LPCC
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Telephone | 216-714-2910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | E.1700425
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License Number State | OH
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