Healthcare Provider Details

I. General information

NPI: 1891808648
Provider Name (Legal Business Name): NEWARK-GRANVILLE PSYCHOLOGICAL & COUNSELING SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 RIVER RD
GRANVILLE OH
43023-9534
US

IV. Provider business mailing address

PO BOX 481
GRANVILLE OH
43023-0481
US

V. Phone/Fax

Practice location:
  • Phone: 740-587-5252
  • Fax: 740-587-2571
Mailing address:
  • Phone: 740-587-5252
  • Fax: 740-587-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: MCKENZIE A POVLINKO
Title or Position: OWNER
Credential:
Phone: 740-587-5252