Provider Demographics
NPI:1588069975
Name:CENTER FOR CLINICAL PSYCHOLOGY INC
Entity type:Organization
Organization Name:CENTER FOR CLINICAL PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-263-0266
Mailing Address - Street 1:35590 CENTER RIDGE RD
Mailing Address - Street 2:# 105
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-6000
Mailing Address - Country:US
Mailing Address - Phone:440-263-0266
Mailing Address - Fax:440-348-2362
Practice Address - Street 1:35590 CENTER RIDGE RD
Practice Address - Street 2:# 105
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-6000
Practice Address - Country:US
Practice Address - Phone:440-263-0266
Practice Address - Fax:440-348-2362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty