Provider Demographics
NPI:1558189019
Name:GRACE GROVE HEALING LLC
Entity type:Organization
Organization Name:GRACE GROVE HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERLITTI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:330-734-5230
Mailing Address - Street 1:4301 DARROW RD # 4450
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2694
Mailing Address - Country:US
Mailing Address - Phone:330-734-5230
Mailing Address - Fax:
Practice Address - Street 1:4301 DARROW RD # 4450
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2694
Practice Address - Country:US
Practice Address - Phone:330-734-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health