Healthcare Provider Details

I. General information

NPI: 1548805781
Provider Name (Legal Business Name): GEROPSYCH COUNSELING, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 ORCHARDVIEW RD
SEVEN HILLS OH
44131-5836
US

IV. Provider business mailing address

151 ORCHARDVIEW RD
SEVEN HILLS OH
44131-5836
US

V. Phone/Fax

Practice location:
  • Phone: 855-437-6779
  • Fax: 855-437-6395
Mailing address:
  • Phone: 855-437-6779
  • Fax: 855-437-6395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW J HILFER
Title or Position: CEO
Credential:
Phone: 855-437-6779