MEDICARE: MRS. JANA MOVSESIAN LPCC, RN, LICDC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	944131	OH
2	101YM0800X	Mental Health Counselor	E.0003863	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000297714	OTHER	OH	ANTHEM BLUE CROSS PIN #

General Provider Information

NPI Number	:	1164504569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANA MOVSESIAN LPCC, RN, LICDC

Provider Business Mailing Address
First Line	:	640 N MAIN ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-3017
Country	:	US
Telephone Number	:	330-762-7481
Fax Number	:	330-762-7484

Provider Business Practice Location Address
First Line	:	640 N MAIN ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-3017
Country	:	US
Telephone Number	:	330-762-7481
Fax Number	:	330-762-7484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	01/12/2012

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