Healthcare Provider Details

I. General information

NPI: 1275622102
Provider Name (Legal Business Name): MONICA ROSS REIDER EDD,LPCC-S,NCC,CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S COURT ST STE 5
MEDINA OH
44256-2259
US

IV. Provider business mailing address

230 S COURT ST STE 5
MEDINA OH
44256-2259
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-7977
  • Fax:
Mailing address:
  • Phone: 330-723-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0500564
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: