Healthcare Provider Details

I. General information

NPI: 1619637931
Provider Name (Legal Business Name): JAMES URWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 ABBE RD
ELYRIA OH
44035-1612
US

IV. Provider business mailing address

5445 SMITH RD
BROOKPARK OH
44142-2026
US

V. Phone/Fax

Practice location:
  • Phone: 440-406-5323
  • Fax:
Mailing address:
  • Phone: 216-332-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC2304940
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: