MEDICARE: NICHOLAS THEODORE NOVAK CT

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	101YM0800X	Mental Health Counselor	C.2507432	OH

General Provider Information

NPI Number	:	1912752304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS THEODORE NOVAK CT

Provider Business Mailing Address
First Line	:	18780 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3303
Country	:	US
Telephone Number	:	440-816-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	18780 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3303
Country	:	US
Telephone Number	:	440-816-8200
Fax Number	:

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

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	12/13/2025

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