Wildgrove Counseling

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

WILDGROVE COUNSELING

Practice address

34900 Chardon Rd BLDG 1
Willoughby Hills, OH 44094-9161

Phone

(440) 739-3626

NPI assigned

Oct 16, 2023

Organization subpart

No

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

Authorized official

Name

Amber Blackston-Balogh, LISW-SNPI 1356635072

Title

Owner

Phone

(419) 302-2575

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Amber N Blackston-Balogh, MSSA, LSW

  • Clinical Social Worker
  • Mentor, OH
  • NPI 1356635072
  NPD Authorized official

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

{
    "created_epoch": "1697414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1992587000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 LYNDHURST RD",
            "city": "LYNDHURST",
            "state": "OH",
            "postal_code": "441242857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34900 CHARDON RD BLDG 1",
            "city": "WILLOUGHBY HILLS",
            "state": "OH",
            "postal_code": "440949161",
            "telephone_number": "440-739-3626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDGROVE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-16",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-15",
        "status": "A",
        "authorized_official_last_name": "BLACKSTON-BALOGH",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-302-2575",
        "authorized_official_credential": "LISW-S"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia M. Welle, L.P.C.C.
• Eric Whalen, DPT
• Lauren Whitehouse
• Chelsea Monique Wicks
• Jessica M Wiener, PC
• Benetta Williams
• Latoreal Lindsey Williams
• Nicholas Williams, PT
• Rainese Williams
• Taraeja R Williams

• Mental Health Clinic/Center (Including Community Mental Health Center) in Willoughby Hills, OH
• Providers in Willoughby Hills, OH by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; 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.