=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346826377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE COUNSELING AND RECOVERY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2021
-----------------------------------------------------
Last Update Date | 04/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6800 W CENTRAL AVE STE D2
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43617-1157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-841-2298
-----------------------------------------------------
Fax | 419-452-4769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3768 COREY RD
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43615-1170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-377-7083
-----------------------------------------------------
Fax | 419-452-4769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. JAMES J BULDAS
-----------------------------------------------------
Credential | ED.D.
-----------------------------------------------------
Telephone | 419-841-2298
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------