Provider Demographics
NPI:1417553678
Name:TOMBAKOGLU, VENUS
Entity Type:Individual
Prefix:MRS
First Name:VENUS
Middle Name:
Last Name:TOMBAKOGLU
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 1:36 PUBLIC SQ STE 202
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7874
Mailing Address - Country:US
Mailing Address - Phone:440-488-4081
Mailing Address - Fax:
Practice Address - Street 1:36 PUBLIC SQ STE 202
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7874
Practice Address - Country:US
Practice Address - Phone:440-488-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.00084454-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health