Provider Demographics
NPI:1891783064
Name:ROYCE, MOLLIE A (PCC)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:A
Last Name:ROYCE
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:A
Other - Last Name:RUTHRAUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCC
Mailing Address - Street 1:2321 SECOND ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2520
Mailing Address - Country:US
Mailing Address - Phone:330-814-1001
Mailing Address - Fax:330-865-5556
Practice Address - Street 1:2321 SECOND ST
Practice Address - Street 2:SUITE 116
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2520
Practice Address - Country:US
Practice Address - Phone:330-814-1001
Practice Address - Fax:330-865-5556
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0003455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH694029OtherANTHEM BCBS