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General NPI Number Information
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NPI Number | 1700713534
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Entity Type | Organization
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Legal Business Name | NORTHSTAR PSYCHOLOGICAL LLC
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 6500 ROCKSIDE RD STE 150
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2367
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Country | US
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Telephone | 330-331-7506
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Fax |
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Provider Business Mailing Address
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Address Line | 6363 PROMWAY AVE NW STE 150
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City | CANTON
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State | OH
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Zip | 44720-7619
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Country | US
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Telephone | 330-331-7506
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | STACY STOUT
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Credential |
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Telephone | 330-331-7506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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