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NPI Code Detail

MEDICARE: BLICK CLINIC, INC.

MEDICARE: BLICK CLINIC, INC.
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10140OTHEROHODMH CERTIFICATION NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952371403
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLICK CLINIC, INC.
Provider Business Mailing Address
First Line : 640 W MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44303-1413
Country : US
Telephone Number : 330-762-5425
Fax Number : 330-762-4019
Provider Business Practice Location Address
First Line : 640 W MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44303-1413
Country : US
Telephone Number : 330-762-5425
Fax Number : 330-762-4019
Authorized Official
Title or Position : DIRECTOR OF CLINICAL SERVICES
Name : MS. KARIN M LOPPER-ORR
Credential : L.I.S.W.
Telephone Number : 330-762-5425
Provider Enumeration Date : 01/26/2006
Last Update Date : 09/08/2016

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