Provider Demographics
NPI:1235354473
Name:TOTAL CARE PSYCHOLOGICAL & COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:TOTAL CARE PSYCHOLOGICAL & COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:NEWELL
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-782-7701
Mailing Address - Street 1:5500 MARKET ST
Mailing Address - Street 2:SUITE 90
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2601
Mailing Address - Country:US
Mailing Address - Phone:330-782-7701
Mailing Address - Fax:330-782-8785
Practice Address - Street 1:5500 MARKET ST
Practice Address - Street 2:SUITE 90
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2601
Practice Address - Country:US
Practice Address - Phone:330-782-7701
Practice Address - Fax:330-782-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4312103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7972009OtherAETNA
OH96550OtherCIGNA
OH306089OtherMHN
OH166850OtherANTHEM
OH0027898OtherTRI CARE
OH1445316OtherHIGHMARK