Provider Demographics
NPI:1306109095
Name:TOLLOTI, MICHAEL P (LPCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:TOLLOTI
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 LASATER DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-1717
Mailing Address - Country:US
Mailing Address - Phone:216-365-8525
Mailing Address - Fax:
Practice Address - Street 1:3570 EXECUTIVE DR STE 201-A
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-6713
Practice Address - Country:US
Practice Address - Phone:216-365-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193986Medicaid