Facts
- Status
- A
- Credential
- LPCC
- Type
- Individual
- Enumeration date
- 2021-07-21
- Last updated
- 2024-09-30
Specialties
Licenses
- License OH
- E.2404669
Location
- Practice location
- 16 EVANS AVE
- City
- AUSTINTOWN OH
- Postal code
- 445151621
- Phone
- 330-330-8655
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.