| Blended | |
|
15400 Pearl Rd Ste 236 Strongsville OH 44136-6000 | |
| (216) 395-7144 | |
| (216) 245-3634 |
| Full Name | Blended |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 15400 Pearl Rd Ste 236, Strongsville, Ohio |
| Authorized Official Name and Position | Xavier Spencer (OWNER) |
| Authorized Official Contact | 2133957144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blended 15400 Pearl Rd Ste 236 Strongsville OH 44136-6000 Ph: (216) 395-7144 | Blended 15400 Pearl Rd Ste 236 Strongsville OH 44136-6000 Ph: (216) 395-7144 |
| NPI Number | 1205332400 |
|---|---|
| Provider Enumeration Date | 04/05/2018 |
| Last Update Date | 12/14/2023 |
| Certification Date | 12/14/2023 |
| Medicare PECOS PAC ID | 2961848882 |
|---|---|
| Medicare Enrollment ID | O20240313002205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205332400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | F1300005 (Ohio) | Primary |
| Provider Name | Xavier Aubrey Spencer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1942535240 PECOS PAC ID: 3870939796 Enrollment ID: I20240313002387 |
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