Provider Demographics
NPI:1902320203
Name:TREE OF LIFE COUNSELING AND TRAINING CENTER, INC.
Entity type:Organization
Organization Name:TREE OF LIFE COUNSELING AND TRAINING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LICDC
Authorized Official - Phone:440-787-6311
Mailing Address - Street 1:24500 CENTER RIDGE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5604
Mailing Address - Country:US
Mailing Address - Phone:440-787-6311
Mailing Address - Fax:
Practice Address - Street 1:24500 CENTER RIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5604
Practice Address - Country:US
Practice Address - Phone:440-787-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0824657Medicaid