Healthcare Provider Details

I. General information

NPI: 1891092128
Provider Name (Legal Business Name): MICHAEL J SKODA LPCC-S, LICDC, SAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 TOWN CENTRE DR STE 600
BROADVIEW HEIGHTS OH
44147-4052
US

IV. Provider business mailing address

7750 TOWN CENTRE DR STE 600
BROADVIEW HEIGHTS OH
44147-4052
US

V. Phone/Fax

Practice location:
  • Phone: 440-547-8200
  • Fax:
Mailing address:
  • Phone: 440-547-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.141063
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1000455-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: