Provider Demographics
NPI:1487985537
Name:SEASONS PRACTICE
Entity type:Organization
Organization Name:SEASONS PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESCIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-243-6530
Mailing Address - Street 1:7055 ENGLE RD
Mailing Address - Street 2:401
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8491
Mailing Address - Country:US
Mailing Address - Phone:440-243-6370
Mailing Address - Fax:440-243-6955
Practice Address - Street 1:7055 ENGLE RD
Practice Address - Street 2:401
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-8491
Practice Address - Country:US
Practice Address - Phone:440-243-6370
Practice Address - Fax:440-243-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0001310101YM0800X
OHI00008011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty