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NPI Code Detail

MEDICARE: JANE D RICHARD M.A., L.P.C.C.

MEDICARE: JANE D RICHARD M.A., L.P.C.C.
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
1101YM0800XMental Health CounselorE.0501051OH
2101YP2500XProfessional CounselorC0501051OH

General Provider Information

NPI Number : 1578613212
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE D RICHARD M.A., L.P.C.C.
Provider Business Mailing Address
First Line : 4335 COPLEY RD
Second Line :
City : COPLEY
State : OH
Zip : 44321-1809
Country : US
Telephone Number : 330-620-4296
Fax Number :
Provider Business Practice Location Address
First Line : 2680 W MARKET ST
Second Line :
City : FAIRLAWN
State : OH
Zip : 44333-4215
Country : US
Telephone Number : 234-867-5001
Fax Number : 234-867-5002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 12/16/2024

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