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General NPI Number Information
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NPI Number | 1902512809
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Entity Type | Organization
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Legal Business Name | MELISSA PANTEL-KU LISW-S LLC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 19910 MALVERN RD STE 201
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-2823
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Country | US
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Telephone | 440-227-1955
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Fax |
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Provider Business Mailing Address
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Address Line | 17666 STOCKTON LN
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City | CHAGRIN FALLS
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State | OH
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Zip | 44023-5741
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Country | US
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Telephone | 440-227-1955
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MELISSA PANTEL-KU
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Credential | LISW-S
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Telephone | 440-227-1955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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