MEDICARE: JACKIE B PAVAL

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	101YM0800X	Mental Health Counselor	1902365	OH

General Provider Information

NPI Number	:	1740827740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE B PAVAL

Provider Business Mailing Address
First Line	:	6264 BIG CREEK PKWY APT 6C
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-2207
Country	:	US
Telephone Number	:	216-548-9406
Fax Number	:

Provider Business Practice Location Address
First Line	:	9701 BROOKPARK RD # 241C
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-6824
Country	:	US
Telephone Number	:	216-548-9406
Fax Number	:

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

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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Directions to “ JACKIE B PAVAL ” Practice Location

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