Individual
MAITLINN THEBERGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14701 DETROIT AVE, LAKEWOOD, OH 44107-4115
(216) 766-6080
Mailing address
14701 DETROIT AVE, LAKEWOOD, OH 44107-4115
(216) 766-6080
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2910854
—
OH
Enumeration date
09/30/2022
Last updated
02/15/2026
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