Healthcare Provider Details

I. General information

NPI: 1568395333
Provider Name (Legal Business Name): CALEB JOEL MICK PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26716 E OVIATT RD
BAY VILLAGE OH
44140-2447
US

IV. Provider business mailing address

26716 E OVIATT RD
BAY VILLAGE OH
44140-2447
US

V. Phone/Fax

Practice location:
  • Phone: 412-780-1608
  • Fax:
Mailing address:
  • Phone: 412-780-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: