Organization
CHILD AND ADOLESCENT BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY SHAHAN (HR ADMIN ASST/CREDENTIALING)
(330) 433-6075
Entity
Organization
Contact information
Practice address
4641 FULTON DR NW, CANTON, OH 44718-2384
(330) 433-6075
(330) 494-0299
Mailing address
4641 FULTON DR NW, CANTON, OH 44718-2384
(330) 433-6075
(330) 494-0299
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0309550
—
OH
05
—
2846844
—
OH
Enumeration date
08/08/2018
Last updated
08/21/2025
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