Healthcare Provider Details

I. General information

NPI: 1932451812
Provider Name (Legal Business Name): NIKONA THOMAS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13422 KINSMAN RD
CLEVELAND OH
44120-4410
US

IV. Provider business mailing address

13422 KINSMAN RD
CLEVELAND OH
44120-4410
US

V. Phone/Fax

Practice location:
  • Phone: 216-283-4400
  • Fax:
Mailing address:
  • Phone: 216-283-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0007371
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: