Organization
GENYSIS RESTORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ETHEL MIDDLEBROOKS DEGREE (CHIEF EXECUTIVE OFFICER)
(216) 299-8789
Entity
Organization
Contact information
Practice address
324 EUCLID SQUARE MALL, EUCLID, OH 44132-2808
(216) 299-8789
Mailing address
324 EUCLID SQUARE MALL, EUCLID, OH 44132-2808
(216) 299-8789
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0000000
OH
101YM0800X
Mental Health Counselor
Primary
OH1037248
OH
101YP1600X
Pastoral Counselor
0000000
OH
101YS0200X
School Counselor
0000000
OH
103TA0400X
Addiction (Substance Use Disorder) Psychologist
0000000
OH
103TM1800X
Intellectual & Developmental Disabilities Psychologist
000000
OH
103TP2701X
Group Psychotherapy Psychologist
000000
OH
103TR0400X
Rehabilitation Psychologist
000000
OH
1041C0700X
Clinical Social Worker
000000
OH
106H00000X
Marriage & Family Therapist
000000
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000000
—
OH
Enumeration date
03/16/2015
Last updated
03/16/2015
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