MEDICARE: TERRY R TOBIAS PHD & 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	103TC0700X	Clinical Psychologist	OH4124	OH

General Provider Information

NPI Number	:	1982035929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRY R TOBIAS PHD & ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	12429 CEDAR RD
Second Line	:	STE 16
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-3163
Country	:	US
Telephone Number	:	216-791-8009
Fax Number	:	216-791-8013

Provider Business Practice Location Address
First Line	:	12429 CEDAR RD
Second Line	:	STE 16
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-3163
Country	:	US
Telephone Number	:	216-791-8009
Fax Number	:	216-791-8013

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. TERRY RUTH TOBIAS
Credential	:	PHD
Telephone Number	:	216-791-8009

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	09/08/2017

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