Healthcare Provider Details

I. General information

NPI: 1851864219
Provider Name (Legal Business Name): CLINIC OF INDIVIDUAL AND FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SOUTH FORGE STREET
AKRON OH
44325-5007
US

IV. Provider business mailing address

27 SOUTH FORGE STREET
AKRON OH
44325-5007
US

V. Phone/Fax

Practice location:
  • Phone: 330-972-6822
  • Fax: 330-972-5599
Mailing address:
  • Phone: 330-972-6822
  • Fax: 330-972-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: REX RAMSIER
Title or Position: EXEC, VP & CHIEF ADMIN. OFFICER
Credential:
Phone: 330-972-7593