Healthcare Provider Details

I. General information

NPI: 1790952000
Provider Name (Legal Business Name): LANDINGS FAMILY & PSYCHOLOGICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32730 WALKER RD SUITE I-5
AVON LAKE OH
44012-4100
US

IV. Provider business mailing address

32730 WALKER RD SUITE I-5
AVON LAKE OH
44012-4100
US

V. Phone/Fax

Practice location:
  • Phone: 440-933-8770
  • Fax: 440-933-8991
Mailing address:
  • Phone: 440-933-8770
  • Fax: 440-933-8991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1813
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1717
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1878
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI2914
License Number StateOH

VIII. Authorized Official

Name: DR. RONALD J MISTUR
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 440-933-8770