Healthcare Provider Details

I. General information

NPI: 1104301407
Provider Name (Legal Business Name): SKODA & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26777 LORAIN RD STE 403
NORTH OLMSTED OH
44070-3224
US

IV. Provider business mailing address

26777 LORAIN RD STE 403
NORTH OLMSTED OH
44070-3224
US

V. Phone/Fax

Practice location:
  • Phone: 440-220-6926
  • Fax: 440-220-7750
Mailing address:
  • Phone: 440-220-6926
  • Fax: 440-220-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J SKODA
Title or Position: CEO & CLINICAL DIRECTOR
Credential: LPCC, LICDC, SAP
Phone: 440-220-6926