Provider Demographics
NPI:1538979836
Name:BEZILLA, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BEZILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 FISHCREEK RD # 946
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4304
Mailing Address - Country:US
Mailing Address - Phone:216-389-4098
Mailing Address - Fax:
Practice Address - Street 1:26777 LORAIN RD STE 317
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3225
Practice Address - Country:US
Practice Address - Phone:216-389-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406422-TRNE101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional