Provider Demographics
NPI:1457080194
Name:PROKOP, ALIZA
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:PROKOP
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 1:5114 KEN LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473-9723
Mailing Address - Country:US
Mailing Address - Phone:330-716-0182
Mailing Address - Fax:
Practice Address - Street 1:5114 KEN LN
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:OH
Practice Address - Zip Code:44473-9723
Practice Address - Country:US
Practice Address - Phone:330-716-0182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health