Healthcare Provider Details

I. General information

NPI: 1750693388
Provider Name (Legal Business Name): MARK SPURGEON KURCSAK PCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MAIN ST
AKRON OH
44310-3110
US

IV. Provider business mailing address

4792 MUNSON ST NW
CANTON OH
44718-3630
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-5078
  • Fax: 330-379-5311
Mailing address:
  • Phone: 330-494-4636
  • Fax: 330-494-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0500575
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: