=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902678089
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | START WITH HOPE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2023
-----------------------------------------------------
Last Update Date | 10/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1206 N MAIN ST STE 123
-----------------------------------------------------
City | NORTH CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44720-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 234-200-5780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2101
-----------------------------------------------------
City | NORTH CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44720-0101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 234-200-5780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL, CLINICIAN
-----------------------------------------------------
Name | TRACY WITH HOPE BERESH
-----------------------------------------------------
Credential | LISW-S
-----------------------------------------------------
Telephone | 234-200-5780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------