Healthcare Provider Details

I. General information

NPI: 1811569908
Provider Name (Legal Business Name): ZACHARY JAMES KLOOCK LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 EUCLID AVE
CLEVELAND OH
44103-3736
US

IV. Provider business mailing address

20131 ARDWELL DR
EUCLID OH
44123-1801
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-3999
  • Fax:
Mailing address:
  • Phone: 440-986-0803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2405793
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: