MEDICARE: FAIRMOUNT PROFESSIONAL SERVICES, INC

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	103T00000X	Psychologist	137	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1215264056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRMOUNT PROFESSIONAL SERVICES, INC

Provider Business Mailing Address
First Line	:	2490 LEE BLVD
Second Line	:	SUITE 314
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1268
Country	:	US
Telephone Number	:	216-321-6624
Fax Number	:

Provider Business Practice Location Address
First Line	:	2490 LEE BLVD
Second Line	:	SUITE 314
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1268
Country	:	US
Telephone Number	:	216-321-6624
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MELVIN EUGENE ALLERHAND
Credential	:	PHD
Telephone Number	:	216-321-6624

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	11/16/2009

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Directions to “FAIRMOUNT PROFESSIONAL SERVICES, INC ” Practice Location

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