=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669876827
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT ALLAN SOEDER ED.S, LPCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2014
-----------------------------------------------------
Last Update Date | 09/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8351 MENTOR AVE
-----------------------------------------------------
City | MENTOR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-5749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-839-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2592 FENWICK RD
-----------------------------------------------------
City | UNIVERSITY HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-4427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-441-1128
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | E.1901329
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------