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General NPI Number Information
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NPI Number | 1316778962
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Entity Type | Individual
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Provider Name | BRYCE BORON CT
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Gender | Male
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 4983 RIDGE RD STE A
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City | WADSWORTH
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State | OH
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Zip | 44281-9738
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Country | US
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Telephone | 440-596-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 20435 KELSEY LN
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City | STRONGSVILLE
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State | OH
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Zip | 44149-0967
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Country | US
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Telephone | 440-596-1411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2405802-TRNE
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License Number State | OH
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