=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659010668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPPING STONE COMMUNITY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2022
-----------------------------------------------------
Last Update Date | 06/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223 W MAIN ST
-----------------------------------------------------
City | RAVENNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44266-2741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-577-4099
-----------------------------------------------------
Fax | 844-274-3002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 223 W MAIN ST
-----------------------------------------------------
City | RAVENNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44266-2741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-577-4099
-----------------------------------------------------
Fax | 844-274-3002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | BETHANY LATIMER
-----------------------------------------------------
Credential | LPCC-S
-----------------------------------------------------
Telephone | 330-577-4099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------