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NPI Code Detail

MEDICARE: RICHARD JUSTIN FLICK BCBA,COBA

MEDICARE: RICHARD JUSTIN FLICK BCBA,COBA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2103K00000XBehavior AnalystCOBA.00929OH

General Provider Information

NPI Number : 1497273189
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD JUSTIN FLICK BCBA,COBA
Provider Business Mailing Address
First Line : 52 S CADILLAC DR
Second Line :
City : BOARDMAN
State : OH
Zip : 44512-3320
Country : US
Telephone Number : 234-866-0141
Fax Number :
Provider Business Practice Location Address
First Line : 1051 TIFFANY S STE A
Second Line :
City : POLAND
State : OH
Zip : 44514-1977
Country : US
Telephone Number : 856-629-6277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2017
Last Update Date : 04/09/2024

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