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General NPI Number Information
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NPI Number | 1710228614
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Entity Type | Organization
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Legal Business Name | CLEVELAND FAMILY THERAPY LLC
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Dates
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Enumeration Date | 03/03/2013
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Last Update Date | 03/03/2013
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Provider Practice Location Address
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Address Line | 23360 CHAGRIN BLVD SUITE 102
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City | BEACHWOOD
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State | OH
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Zip | 44122-5537
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Country | US
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Telephone | 440-210-4763
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Fax |
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Provider Business Mailing Address
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Address Line | 23360 CHAGRIN BLVD SUITE 102
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City | BEACHWOOD
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State | OH
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Zip | 44122-5537
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Country | US
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Telephone | 440-210-4763
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA COAN
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Credential | LCDCIII,PC
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Telephone | 440-210-4763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 021164
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C0501110
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License Number State | OH
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