Healthcare Provider Details

I. General information

NPI: 1295250934
Provider Name (Legal Business Name): ALISSA C HUTH-BOCKS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

20800 HARVARD RD FL 2
HIGHLAND HILLS OH
44122-7250
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: