Provider Demographics
NPI:1053746750
Name:TERRENCE KELLEMAN COUNSELING INC
Entity type:Organization
Organization Name:TERRENCE KELLEMAN COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KELLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:440-356-2286
Mailing Address - Street 1:23550 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3655
Mailing Address - Country:US
Mailing Address - Phone:440-356-2286
Mailing Address - Fax:440-331-3021
Practice Address - Street 1:23550 CENTER RIDGE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-3655
Practice Address - Country:US
Practice Address - Phone:440-356-2286
Practice Address - Fax:440-331-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH912985101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty