=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972551141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIALTY CARE COUNSELING SERVICES, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 E MARKET ST
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44483-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-399-1221
-----------------------------------------------------
Fax | 330-399-1205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 E MARKET ST
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44483-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-399-1221
-----------------------------------------------------
Fax | 330-399-1205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST/OWNER
-----------------------------------------------------
Name | DR. EHAB SARGIOUS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 330-399-1221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0540
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------