Organization Active NPI

Tree of Life Therapy LLC

  • Clinical Social Worker
  • Berea, OH
National Provider Identifier
1871369579
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
TREE OF LIFE THERAPY LLC
Practice address
398 W Bagley Rd Ste 215
Berea, OH 44017-1312
Phone
(216) 282-4749
NPI assigned
Dec 4, 2023
Last updated
Jan 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Authorized official

Name
Tracy Dawn, LISW
Title
Director
Phone
(216) 282-4749

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X
Counselor 101Y00000X
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

398 W Bagley Rd Ste 215
Berea, OH 44017-1312

Mailing address

34760 Center Ridge Rd Unit 39533
North Ridgeville, OH 44039-4722
Phone (216) 282-4749

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, OH, WA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20241202000014 PA Part B Supplier - Clinic/Group Practice 8123553047 Receives reassigned benefits from 1 practitioner
Practice locations: Erie, PA
O20250121002295 OH Part B Supplier - Clinic/Group Practice 8123553047 Receives reassigned benefits from 1 practitioner
Practice locations: Parma, OH
O20260219000279 WA Part B Supplier - Clinic/Group Practice 8123553047 Receives reassigned benefits from 1 practitioner
Practice locations: Ephrata, WA

National Provider Directory

National Provider Directory

Locations

34760 Center Ridge Rd
Unit 39533
North Ridgeville, OH 44039
Phone (216) 282-4749

15500 Pearl Rd
Unit 360044
Strongsville, OH 44136

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1871369579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34760 CENTER RIDGE RD UNIT 39533",
            "city": "NORTH RIDGEVILLE",
            "state": "OH",
            "postal_code": "440394722",
            "telephone_number": "216-282-4749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "398 W BAGLEY RD STE 215",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171312",
            "telephone_number": "216-282-4749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TREE OF LIFE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "DAWN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "216-282-4749",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berea, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.