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2680 West Market St Fairlawn OH 44333-4215 | |
| (234) 867-5001 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2680 West Market St, Fairlawn, Ohio |
| Authorized Official Name and Position | Stephen Dunleavey (CO-OWNER) |
| Authorized Official Contact | 2348675001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2680 West Market St. Fairlawn OH 44333-4215 Ph: () - | 2680 West Market St Fairlawn OH 44333-4215 Ph: (234) 867-5001 |
| NPI Number | 1154904332 |
|---|---|
| Provider Enumeration Date | 05/04/2021 |
| Last Update Date | 12/02/2021 |
| Certification Date | 12/02/2021 |
| Medicare PECOS PAC ID | 9638614555 |
|---|---|
| Medicare Enrollment ID | O20240715003439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154904332 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Stephen W Dunleavey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568516870 PECOS PAC ID: 3678018660 Enrollment ID: I20240729002433 |
| Provider Name | Victoria Ann Gutbrod |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740339977 PECOS PAC ID: 0840735833 Enrollment ID: I20240829001749 |
| Provider Name | Jane D Richard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578613212 PECOS PAC ID: 4981135662 Enrollment ID: I20241004002844 |
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