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NPI Code Detail

MEDICARE: PHYLLIS MARIS MA, LPCC

MEDICARE: PHYLLIS MARIS MA, LPCC
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
1101YP2500XProfessional CounselorE-1160OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000124711OTHEROHANTHEM BLUE CROSS

General Provider Information

NPI Number : 1982647152
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS MARIS MA, LPCC
Provider Business Mailing Address
First Line : 2525 E 22ND ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-3202
Country : US
Telephone Number : 216-459-9827
Fax Number : 216-696-6592
Provider Business Practice Location Address
First Line : 2525 E 22ND ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-3202
Country : US
Telephone Number : 216-459-9827
Fax Number : 216-696-6592
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 07/08/2007

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Directions to “ PHYLLIS MARIS MA, LPCC” Practice Location

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