MEDICARE: MR. MICHAEL J SKODA LPCC-S, LICDC, SAP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.141063	OH
2	101YP2500X	Professional Counselor	E.1000455-SUPV	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	:	1891092128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL J SKODA LPCC-S, LICDC, SAP

Provider Business Mailing Address
First Line	:	7750 TOWN CENTRE DR STE 600
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4052
Country	:	US
Telephone Number	:	440-547-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7750 TOWN CENTRE DR STE 600
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4052
Country	:	US
Telephone Number	:	440-547-8200
Fax Number	:

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

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	04/08/2026

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