Organization
HOLDING SPACE LLC
Active
Other names
Tiffany Manrodt
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY MANRODT LISW-S (CLINICAL DIRECTOR, LISW)
(440) 226-6531
Entity
Organization
Contact information
Practice address
24481 DETROIT RD STE 201, WESTLAKE, OH 44145-1557
(440) 310-6361
(440) 625-2592
Mailing address
24481 DETROIT RD STE 201, WESTLAKE, OH 44145-1557
(440) 310-6361
(440) 625-2592
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
04/21/2019
Last updated
05/04/2022
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