Organization
WILDGROVE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER BLACKSTON-BALOGH LISW-S (OWNER)
(419) 302-2575
Entity
Organization
Contact information
Practice address
34900 CHARDON RD BLDG 1, WILLOUGHBY HILLS, OH 44094-9161
(440) 739-3626
Mailing address
1531 LYNDHURST RD, LYNDHURST, OH 44124-2857
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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