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General NPI Number Information
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NPI Number | 1093296261
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Entity Type | Organization
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Legal Business Name | KENDRA A MATHYS PSYD LLC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 15644 MADISON AVE STE 202
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City | LAKEWOOD
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State | OH
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Zip | 44107-5622
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Country | US
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Telephone | 440-202-1708
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Fax | 440-287-9707
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Provider Business Mailing Address
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Address Line | 15644 MADISON AVE STE 202
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City | LAKEWOOD
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State | OH
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Zip | 44107-5622
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Country | US
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Telephone | 440-202-1708
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Fax | 440-287-9707
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Authorized Official
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Title or Position | OWNER
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Name | KENDRA MATHYS
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Credential | PSYD
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Telephone | 440-202-1708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P.7357
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License Number State | OH
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