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NPI Code Detail

MEDICARE: MR. GALEN W. SIEVERT PCC-S, LICDC-CS

MEDICARE: MR. GALEN W. SIEVERT PCC-S, LICDC-CS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor051036OH
2101YP2500XProfessional CounselorE7470OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104930858
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GALEN W. SIEVERT PCC-S, LICDC-CS
Provider Business Mailing Address
First Line : 1506 WOODBINE AVE
Second Line :
City : AKRON
State : OH
Zip : 44313-7632
Country : US
Telephone Number : 330-622-5111
Fax Number :
Provider Business Practice Location Address
First Line : 3445 S MAIN ST
Second Line :
City : COVENTRY TOWNSHIP
State : OH
Zip : 44319-3028
Country : US
Telephone Number : 330-644-4095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 04/28/2020

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