Provider Demographics
NPI:1467872689
Name:GLOVAN POLLAK AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:GLOVAN POLLAK AND ASSOCIATES LLC
Other - Org Name:THE BEHAVIORAL WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLLAK
Authorized Official - Suffix:
Authorized Official - Credentials:PCC, LICDC
Authorized Official - Phone:440-392-2222
Mailing Address - Street 1:8224 MENTOR AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5768
Mailing Address - Country:US
Mailing Address - Phone:440-392-2222
Mailing Address - Fax:440-565-2349
Practice Address - Street 1:8224 MENTOR AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-392-2222
Practice Address - Fax:440-565-2349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-27
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2273274101Y00000X
101YA0400X, 103TC0700X, 1041C0700X, 261Q00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0216770Medicaid