Healthcare Provider Details

I. General information

NPI: 1598770257
Provider Name (Legal Business Name): BRENDA BARNES TOUSLEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BRADY LAKE RD
RAVENNA OH
44266-1610
US

IV. Provider business mailing address

357 WYOGA LAKE BLVD
CUYAHOGA FALLS OH
44224-1140
US

V. Phone/Fax

Practice location:
  • Phone: 330-678-2400
  • Fax: 330-673-3714
Mailing address:
  • Phone: 330-678-2400
  • Fax: 330-673-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: