=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710784228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNDERSTORY SERVICES AND SUPPORTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7271 ENGLE RD STE 101
-----------------------------------------------------
City | MIDDLEBURG HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-8404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-832-8368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7271 ENGLE RD STE 101
-----------------------------------------------------
City | MIDDLEBURG HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-8404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICIAN
-----------------------------------------------------
Name | DR. AARON MUTTILLO
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 216-832-8368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------