Healthcare Provider Details

I. General information

NPI: 1730895657
Provider Name (Legal Business Name): RHEMINGTIN NYCOLE REXRODE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3591 RESERVE COMMONS DR STE 100
MEDINA OH
44256-5334
US

IV. Provider business mailing address

25700 SCIENCE PARK DR STE 210
BEACHWOOD OH
44122-7328
US

V. Phone/Fax

Practice location:
  • Phone: 261-450-1613
  • Fax: 888-494-1608
Mailing address:
  • Phone: 216-450-1613
  • Fax: 216-450-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2204751
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: