=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578765095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY INSTITUTE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 06/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24500 CENTER RIDGE RD SUITE 185
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-219-3510
-----------------------------------------------------
Fax | 440-455-1410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8995 WYLLYS DR
-----------------------------------------------------
City | NORTH RIDGEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-219-3510
-----------------------------------------------------
Fax | 440-455-1410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BENJAMIN WILLIAMS KEARNEY
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 440-219-3510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2475
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------