Healthcare Provider Details

I. General information

NPI: 1467872689
Provider Name (Legal Business Name): GLOVAN POLLAK AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2014
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8224 MENTOR AVE SUITE 208
MENTOR OH
44060
US

IV. Provider business mailing address

8224 MENTOR AVE SUITE 208
MENTOR OH
44060-5768
US

V. Phone/Fax

Practice location:
  • Phone: 440-392-2222
  • Fax: 440-565-2349
Mailing address:
  • Phone: 440-392-2222
  • Fax: 440-565-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2273274
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J POLLAK
Title or Position: OWNER
Credential: PCC, LICDC
Phone: 440-392-2222