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General NPI Number Information
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NPI Number | 1033409222
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Entity Type | Organization
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Legal Business Name | KSK HEALTH SERVICES LLC
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Dates
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Enumeration Date | 04/09/2011
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 6929 W 130TH ST SUITE 503
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City | PARMA HEIGHTS
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State | OH
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Zip | 44130-7895
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Country | US
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Telephone | 440-481-3055
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Fax | 440-481-3222
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Provider Business Mailing Address
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Address Line | 6929 W 130TH ST SUITE 503
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City | PARMA HEIGHTS
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State | OH
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Zip | 44130-7895
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Country | US
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Telephone | 440-481-3055
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Fax | 440-481-3222
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Authorized Official
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Title or Position | MANAGER/CEO
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Name | STEPHANIE L KIDD
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Credential | LPCC/PCC
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Telephone | 440-481-3055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35099315
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0004052
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0900389
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 35060650
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0007819
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I0007634
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License Number State | OH
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Taxonomy #7
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6890
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License Number State | OH
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35060650
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License Number State | OH
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