MEDICARE: THE CENTER FOR INDEPENDENCELLC BEHAVIORAL HEALTH AND SPORT PERFORMANCE

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	E0001871	OH

General Provider Information

NPI Number	:	1679545479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR INDEPENDENCELLC BEHAVIORAL HEALTH AND SPORT PERFORMANCE

Provider Business Mailing Address
First Line	:	8137 BISHOPS CT
Second Line	:
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147
Country	:	US
Telephone Number	:	216-402-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 E ROYALTON RD
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2549
Country	:	US
Telephone Number	:	216-402-8200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NANCY LYNN MUSARRA
Credential	:	LPCC PHD
Telephone Number	:	216-402-8200

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	08/22/2020

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