=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457077588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESTORED MINDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2022
-----------------------------------------------------
Last Update Date | 10/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 AUBURN DR STE 200
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-401-5525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 154 E AURORA RD # 103
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44067-2053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-378-2935
-----------------------------------------------------
Fax | 234-808-4400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MA, LLPC
-----------------------------------------------------
Name | DR. AVRIL SARGEANT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-401-5525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------