1235354473 NPI number — TOTAL CARE PSYCHOLOGICAL & COUNSELING SERVICES INC

Table of content: (NPI 1235354473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235354473 NPI number — TOTAL CARE PSYCHOLOGICAL & COUNSELING SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL CARE PSYCHOLOGICAL & COUNSELING SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235354473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 MARKET ST
Provider Second Line Business Mailing Address:
SUITE 90
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44512-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-782-7701
Provider Business Mailing Address Fax Number:
330-782-8785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 90
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44512-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-782-7701
Provider Business Practice Location Address Fax Number:
330-782-8785
Provider Enumeration Date:
04/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALLER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
NEWELL
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
330-782-7701

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  4312 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7972009 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 96550 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 306089 . This is a "MHN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 166850 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0027898 . This is a "TRI CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1445316 . This is a "HIGHMARK" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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