MEDICARE: KALEIDOSCOPE COUNSELING SERVICES

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	5944	OH

General Provider Information

NPI Number	:	1811165277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALEIDOSCOPE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2677 CLEVELAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3393
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2677 CLEVELAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3393
Country	:	US
Telephone Number	:	330-456-9214
Fax Number	:	330-456-9251

Authorized Official
Title or Position	:	PRESIDENT & PSYCHOLOGIST
Name	:	DR. BROCK M. REIMAN
Credential	:	PHD
Telephone Number	:	330-456-9214

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	06/12/2008

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