Kindred Spirit Behavioral Health

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

KINDRED SPIRIT BEHAVIORAL HEALTH

Practice address

3618 W Market St Ste E15
Fairlawn, OH 44333-2425

Phone

(330) 271-6160

NPI assigned

Dec 21, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tania S Lodge, PHDNPI 1437315520

Title

Psychologist/Director

Phone

(330) 271-6160

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Tax ID family

Kindred Spirit Behavioral Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Kindred Spirit Behavioral Health

  • Community/Behavioral Health Agency
  • Fairlawn, OH
  • NPI 1396493185
  NPD tax ID
• Kindred Spirit Behavioral Health

  • Community/Behavioral Health Agency
  • Fairlawn, OH
  • NPI 1871458000
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tania Lodge, PHD, PCC-S

  • Clinical Psychologist
  • Fairlawn, OH
  • NPI 1437315520
  Medicare reassignment NPD Authorized official
• Cheyanna Lateef

  • Social Worker
  • Fairlawn, OH
  • NPI 1235937525
  NPD (past)
• Amber Lewis

  • Student in an Organized Health Care Education/Training Program
  • Fairlawn, OH
  • NPI 1588417364
  NPD (past)
• Lorris Robinson Jr.

  • Student in an Organized Health Care Education/Training Program
  • Fairlawn, OH
  • NPI 1619720489
  NPD (past)
• Kwentor Q Uwechue, MS

  • Professional Counselor
  • Worthington, OH
  • NPI 1760712202
  NPD (past)
• Michael McKinley Williams

  • Addiction (Substance Use Disorder) Counselor
  • Dayton, OH
  • NPI 1598265845
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1093475899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4036",
            "city": "COPLEY",
            "state": "OH",
            "postal_code": "443210036",
            "telephone_number": "330-127-6160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3618 W MARKET ST STE E15",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443332425",
            "telephone_number": "330-271-6160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINDRED SPIRIT BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "LODGE",
        "authorized_official_first_name": "TANIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PSYCHOLOGIST/DIRECTOR",
        "authorized_official_telephone_number": "330-271-6160",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0214582",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tanialodge@kindred-spirit-behaviora.kno2fy.com",
            "affiliation": "N",
            "address_1": "3618 W Market St Ste E15",
            "city": "Fairlawn",
            "state": "OH",
            "country_code": "US",
            "postal_code": "443332425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kevin Laurence Outwater
• Ghassan F Khayyat, MD
• Jill Marie Kiley, LPN
• Rebecca Grace Kilmer
• Jennifer Dasol Kim, DDS
• Kindred Spirit Behavioral Health
• Kindred Spirit Behavioral Health
• Jack Dennis King, MD
• Franciska Kiraly, M.D.
• Kay Klaiber

• Community/Behavioral Health Agency in Fairlawn, OH
• Providers in Fairlawn, OH by specialty
• Community/Behavioral Health Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.