Provider Demographics
NPI:1558535658
Name:VISTA PSYCHOLOGICAL & COUNSELING CENTRE LLC
Entity Type:Organization
Organization Name:VISTA PSYCHOLOGICAL & COUNSELING CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-244-8782
Mailing Address - Street 1:1201 SOUTH MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720
Mailing Address - Country:US
Mailing Address - Phone:330-244-8782
Mailing Address - Fax:330-244-8795
Practice Address - Street 1:1201 SOUTH MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:330-244-8782
Practice Address - Fax:330-244-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty