Healthcare Provider Details

I. General information

NPI: 1255495735
Provider Name (Legal Business Name): KIM METZ PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S COURT ST SUITE 8
MEDINA OH
44256-2259
US

IV. Provider business mailing address

230 S COURT ST SUITE 8
MEDINA OH
44256-2259
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-7977
  • Fax: 330-725-5177
Mailing address:
  • Phone: 330-723-7977
  • Fax: 330-725-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: