Healthcare Provider Details

I. General information

NPI: 1700713534
Provider Name (Legal Business Name): NORTHSTAR PSYCHOLOGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 ROCKSIDE RD STE 150
INDEPENDENCE OH
44131-2367
US

IV. Provider business mailing address

6363 PROMWAY AVE NW STE 150
CANTON OH
44720-7619
US

V. Phone/Fax

Practice location:
  • Phone: 330-331-7506
  • Fax:
Mailing address:
  • Phone: 330-331-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STACY STOUT
Title or Position: BILLING MANAGER
Credential:
Phone: 330-331-7506