Provider Demographics
NPI:1891808648
Name:NEWARK-GRANVILLE PSYCHOLOGICAL & COUNSELING SERVICES LTD
Entity Type:Organization
Organization Name:NEWARK-GRANVILLE PSYCHOLOGICAL & COUNSELING SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPIDUS-MANN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:740-587-5252
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0481
Mailing Address - Country:US
Mailing Address - Phone:740-587-5252
Mailing Address - Fax:740-587-2571
Practice Address - Street 1:945 RIVER RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9534
Practice Address - Country:US
Practice Address - Phone:740-587-5252
Practice Address - Fax:740-587-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9330701Medicare PIN