Organization Active NPI

U1St

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Warren, OH
National Provider Identifier
1093677130
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
U1ST
Practice address
3118 Williamsburg St NW
Warren, OH 44485-2255
Phone
(330) 853-8627
NPI assigned
Nov 26, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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

Authorized official

Name
Ebonie Bourgoin
Title
Owner
Phone
(330) 853-8627

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

3118 Williamsburg St NW
Warren, OH 44485-2255

Mailing address

3118 Williamsburg St NW
Warren, OH 44485-2255
Phone (330) 853-8627

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1764115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764115200000",
    "number": "1093677130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3118 WILLIAMSBURG ST NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444852255",
            "telephone_number": "330-853-8627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3118 WILLIAMSBURG ST NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444852255",
            "telephone_number": "330-853-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "U1ST",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-26",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A",
        "authorized_official_last_name": "BOURGOIN",
        "authorized_official_first_name": "EBONIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-853-8627"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.