Provider Demographics
NPI:1336976521
Name:SIMPLY AMAZING FAMILY ENVIRONMENT
Entity type:Organization
Organization Name:SIMPLY AMAZING FAMILY ENVIRONMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEREENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREAMER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:330-422-9005
Mailing Address - Street 1:9150 MARKET SQUARE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4573
Mailing Address - Country:US
Mailing Address - Phone:330-422-9005
Mailing Address - Fax:
Practice Address - Street 1:9217 STATE ROUTE 43 STE 220
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5371
Practice Address - Country:US
Practice Address - Phone:330-422-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPLY AMAZING FAMILY ENVIRONMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-19
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251B00000XAgenciesCase Management
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0342515Medicaid