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General NPI Number Information
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NPI Number | 1497238380
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Entity Type | Organization
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Legal Business Name | PAW MEADOWS LLC
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 1133 GRANGER RD
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City | MEDINA
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State | OH
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Zip | 44256-8478
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Country | US
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Telephone | 330-542-8555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5235
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City | FAIRLAWN
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State | OH
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Zip | 44334-0235
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Country | US
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Telephone | 330-542-8555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER KNOBLOCH
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Credential | LPCC-S
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Telephone | 330-542-8555
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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 | E.0800239
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License Number State | OH
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