Healthcare Provider Details

I. General information

NPI: 1558535658
Provider Name (Legal Business Name): VISTA PSYCHOLOGICAL & COUNSELING CENTRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 FULTON DR NW STE 4
CANTON OH
44718-2300
US

IV. Provider business mailing address

4845 FULTON DR NW STE 4
CANTON OH
44718-2300
US

V. Phone/Fax

Practice location:
  • Phone: 330-244-8782
  • Fax: 330-244-8795
Mailing address:
  • Phone: 330-244-8782
  • Fax: 330-244-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT A HUMPHRIES
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 330-244-8782