=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477720944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHOLOGICAL & BEHAVIORAL CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2008
-----------------------------------------------------
Last Update Date | 05/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25111 COUNTRY CLUB BLVD STE 290
-----------------------------------------------------
City | NORTH OLMSTED
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44070-5330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-831-2500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1589 WAGAR AVE
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44107-3640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-255-9450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL COUNSELOR
-----------------------------------------------------
Name | MRS. NANCY ANN KLEIN
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 216-255-9450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | E 0003976
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------