Healthcare Provider Details

I. General information

NPI: 1609479427
Provider Name (Legal Business Name): CORY KRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MARKET ST
CELINA OH
45822-1736
US

IV. Provider business mailing address

401 E MARKET ST
CELINA OH
45822-1736
US

V. Phone/Fax

Practice location:
  • Phone: 419-584-5123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: