Provider Demographics
NPI:1679133193
Name:HOSTICKA, JAMES F (LPCC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:HOSTICKA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:HOSTICKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 771125
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107
Mailing Address - Country:US
Mailing Address - Phone:216-543-5792
Mailing Address - Fax:
Practice Address - Street 1:780 E 185TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2174
Practice Address - Country:US
Practice Address - Phone:216-681-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902038101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional