Healthcare Provider Details

I. General information

NPI: 1205803517
Provider Name (Legal Business Name): THOMAS PATRICK LECHOWICK M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W MAIN ST SUITE 107
GENEVA OH
44041-1206
US

IV. Provider business mailing address

203 W MAIN ST SUITE 107
GENEVA OH
44041-1206
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-7775
  • Fax: 440-466-7775
Mailing address:
  • Phone: 440-466-7775
  • Fax: 440-466-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2589
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: