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General NPI Number Information
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NPI Number | 1124030713
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Entity Type | Organization
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Legal Business Name | CHRISCRY COUNSELING SERVICE
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9409 COLUMBIA AVE
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City | CLEVELAND
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State | OH
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Zip | 44108-2911
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Country | US
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Telephone | 216-451-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 9409 COLUMBIA AVE
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City | CLEVELAND
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State | OH
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Zip | 44108-2911
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Country | US
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Telephone | 216-451-1510
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. CRYSTAL LYNN BANKS
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Credential | LISW
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Telephone | 216-451-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I5029
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License Number State | OH
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