Healthcare Provider Details

I. General information

NPI: 1205589488
Provider Name (Legal Business Name): MR. JAMES EDWARD HOAG III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CURRIE HALL PKWY STE A
KENT OH
44240-4312
US

IV. Provider business mailing address

163 CARRIAGE DR APT 204
CHAGRIN FALLS OH
44022-2840
US

V. Phone/Fax

Practice location:
  • Phone: 330-673-5812
  • Fax:
Mailing address:
  • Phone: 216-372-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2305203
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2103699-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: