Provider Demographics
NPI:1205053154
Name:CLOSS, ROBERT LOUIS (PHD, MA,, LICDC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:CLOSS
Suffix:
Gender:M
Credentials:PHD, MA,, LICDC
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:LOUIS
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MA,, LICDC
Mailing Address - Street 1:6800 W CENTRAL AVE
Mailing Address - Street 2:STE B
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1135
Mailing Address - Country:US
Mailing Address - Phone:304-526-2243
Mailing Address - Fax:304-526-2220
Practice Address - Street 1:6800 W CENTRAL AVE
Practice Address - Street 2:STE B
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1135
Practice Address - Country:US
Practice Address - Phone:419-574-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8449101YA0400X
OH6331103TC0700X
WV1078101YA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQ44122AMedicare PIN