1245581180 NPI number — CUNNINGHAM COUNSELING ASSOCIATES L.L.C.

Table of content: (NPI 1245581180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245581180 NPI number — CUNNINGHAM COUNSELING ASSOCIATES L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUNNINGHAM COUNSELING ASSOCIATES L.L.C.
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:
1245581180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20525 DETROIT RD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
ROCKY RIVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44116-2444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-767-5709
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20525 DETROIT RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
ROCKY RIVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44116-2444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-767-5709
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CUNNINGHAM
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
440-409-5486

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I 0008301 , 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: SW35811 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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