Provider Demographics
NPI:1265856207
Name:TINNON, KARIN MERDES
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:MERDES
Last Name:TINNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19426 SCOTTSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6420
Mailing Address - Country:US
Mailing Address - Phone:216-283-6416
Mailing Address - Fax:216-268-6480
Practice Address - Street 1:1843 STANWOOD RD
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2901
Practice Address - Country:US
Practice Address - Phone:216-268-6687
Practice Address - Fax:216-268-6480
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCL1006994103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool