Provider Demographics
NPI:1396797387
Name:NORTHEAST OHIO PSYCHOLOGICAL CONSULTANTS, LTD.
Entity type:Organization
Organization Name:NORTHEAST OHIO PSYCHOLOGICAL CONSULTANTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEWELLYN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-758-3819
Mailing Address - Street 1:839 SOUTHWESTERN RUN
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4688
Mailing Address - Country:US
Mailing Address - Phone:330-758-3819
Mailing Address - Fax:330-758-4965
Practice Address - Street 1:839 SOUTHWESTERN RUN
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-4688
Practice Address - Country:US
Practice Address - Phone:330-758-3819
Practice Address - Fax:330-758-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4295261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11389741OtherCAQH PROVIDER #
OH162919OtherGM/PACKARD/CIGNA #
OH227276000OtherMAGELLAN MIS #
OH4295OtherOHIO LICENSE #
OH000000248739OtherANTHEM #
OH334924OtherMHS #
OHCP03076OtherMEDICARE GROUP
OH11389741OtherCAQH PROVIDER #
OH334924OtherMHS #