| NPI | 1093475899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANIA S LODGE Psychologist/Director 330-271-6160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2022-03-01 |