Healthcare Provider Details

I. General information

NPI: 1538631445
Provider Name (Legal Business Name): GLOVAN POLLAK AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8224 MENTOR AVE STE 208
MENTOR OH
44060-5743
US

IV. Provider business mailing address

8224 MENTOR AVE STE 208
MENTOR OH
44060-5743
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. KATHERINE LONG
Title or Position: CREDENTIALING
Credential:
Phone: 330-523-7251