Provider Demographics
NPI:1245581180
Name:CUNNINGHAM COUNSELING ASSOCIATES L.L.C.
Entity Type:Organization
Organization Name:CUNNINGHAM COUNSELING ASSOCIATES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LISWS, LICDC
Authorized Official - Phone:440-409-5486
Mailing Address - Street 1:20525 DETROIT RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2444
Mailing Address - Country:US
Mailing Address - Phone:216-767-5709
Mailing Address - Fax:
Practice Address - Street 1:20525 DETROIT RD
Practice Address - Street 2:SUITE 6
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2444
Practice Address - Country:US
Practice Address - Phone:216-767-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00083011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW35811OtherMEDICARE PTAN