MEDICARE: PHYLLIS ANN VAIR M.ED., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	C.1500573	OH

General Provider Information

NPI Number	:	1073031373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS ANN VAIR M.ED., LPC

Provider Business Mailing Address
First Line	:	3675 SUMMIT RD
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3513
Country	:	US
Telephone Number	:	330-807-0028
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 E ERIE ST STE 302
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-3594
Country	:	US
Telephone Number	:	330-593-5959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	09/07/2017

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