Provider Demographics
NPI:1942535240
Name:SPENCER, XAVIER AUBREY (IMFT)
Entity Type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:AUBREY
Last Name:SPENCER
Suffix:
Gender:M
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 PEARL RD STE 236
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6000
Mailing Address - Country:US
Mailing Address - Phone:216-395-7144
Mailing Address - Fax:216-245-3634
Practice Address - Street 1:15400 PEARL RD STE 236
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6000
Practice Address - Country:US
Practice Address - Phone:216-395-7144
Practice Address - Fax:216-245-3634
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF1300005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163604Medicaid