MEDICARE: COHR PSYCHOLOGISTS & ASSOCIATES LLC

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

General Provider Information

NPI Number	:	1629811252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COHR PSYCHOLOGISTS & ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	12401 ROCKSIDE RD UNIT 25378
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-7318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9726 PLYMOUTH AVE
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2371
Country	:	US
Telephone Number	:	330-578-4855
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TANISHA L KNIGHTON
Credential	:	PH.D.
Telephone Number	:	330-578-4855

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	06/12/2024

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