Healthcare Provider Details

I. General information

NPI: 1053479170
Provider Name (Legal Business Name): COMPREHENSIVE BEHAVORIAL HEALTH ASSOC.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E STATE ST
SALEM OH
44460-2423
US

IV. Provider business mailing address

321 W 5TH ST
EAST LIVERPOOL OH
43920-2849
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-8800
  • Fax: 330-385-8869
Mailing address:
  • Phone: 330-385-8800
  • Fax: 330-385-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number042814
License Number StateOH

VIII. Authorized Official

Name: DR. KOTESWARA R KAZA
Title or Position: MEDICAL DIRECTOR
Credential: M.D,ABPN
Phone: 330-385-8800