NPIMap

Organization Active NPI

Genysis Restoration

  • Mental Health Counselor
  • Euclid, OH
National Provider Identifier
1659764686
Registry record updated Mar 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
OH1037248 Issued in OH
Legal business name
GENYSIS RESTORATION
Practice address
324 Euclid Square Mall
Euclid, OH 44132-2808
Phone
(216) 299-8789
NPI assigned
Mar 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2015

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

Authorized official

Name
Ethel Middlebrooks, DEGREE
Title
Chief Executive Officer
Phone
(216) 299-8789

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 0000000 OH
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X OH1037248 OH Primary
Pastoral CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP1600X 0000000 OH
School CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YS0200X 0000000 OH
Addiction (Substance Use Disorder) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0400X 0000000 OH
Intellectual & Developmental Disabilities PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TM1800X 000000 OH
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X 000000 OH
Rehabilitation PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TR0400X 000000 OH
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 000000 OH
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 000000 OH

Addresses

Primary practice location

324 Euclid Square Mall
Euclid, OH 44132-2808

Mailing address

324 Euclid Square Mall
Euclid, OH 44132-2808
Phone (216) 299-8789

Other identifiers 1

IdentifierTypeStateIssuer
0000000000MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Genysis Restoration3 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.

NPI Registry JSON

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426464000000",
    "number": "1659764686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 EUCLID SQUARE MALL",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441322808",
            "telephone_number": "216-299-8789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 EUCLID SQUARE MALL",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441322808",
            "telephone_number": "216-299-8789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENYSIS RESTORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-16",
        "last_updated": "2015-03-16",
        "status": "A",
        "authorized_official_last_name": "MIDDLEBROOKS",
        "authorized_official_first_name": "ETHEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "216-299-8789",
        "authorized_official_credential": "DEGREE"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "0000000",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "OH1037248",
            "primary": true
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": "OH",
            "license": "0000000",
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, School",
            "state": "OH",
            "license": "0000000",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "0000000",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "OH",
            "license": "000000",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "OH",
            "license": "000000",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Rehabilitation",
            "state": "OH",
            "license": "000000",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "000000",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "OH",
            "license": "000000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000000000",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Euclid, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; 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.