| NPI | 1982637633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA KEATHLEY Credentialing Specialist 330-676-6826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH 0227) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH 0227) |
| 103T00000X Psychologist (Licence: OH 0227) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: OH 0227) | |
| 103TC0700X Psychologist Clinical (Licence: OH 0227) | |
| 103TC1900X Psychologist Counseling (Licence: OH 0227) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OH 0227) | |
| 104100000X Social Worker (Licence: OH 0227) | |
| 1041C0700X Social Worker Clinical (Licence: OH 0227) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 0227) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: OH 0227) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2007-11-01 |