Healthcare Provider Details

I. General information

NPI: 1720313638
Provider Name (Legal Business Name): ROBERT DARRELL PICKARD SR. LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

IV. Provider business mailing address

355 S BELVOIR BLVD
SOUTH EUCLID OH
44121-2348
US

V. Phone/Fax

Practice location:
  • Phone: 216-694-7200
  • Fax: 216-521-6006
Mailing address:
  • Phone: 216-531-9580
  • Fax: 216-531-9581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0800106
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC 0800106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: