Provider Demographics
NPI:1649303512
Name:WEST MOCK ASSOCIATES, INC DBA CENTER FOR INTERPERSONAL DEVELOPMENT
Entity type:Organization
Organization Name:WEST MOCK ASSOCIATES, INC DBA CENTER FOR INTERPERSONAL DEVELOPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SWIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S SAP
Authorized Official - Phone:216-226-2721
Mailing Address - Street 1:14650 DETROIT AVENUE
Mailing Address - Street 2:SUITE LL40
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107
Mailing Address - Country:US
Mailing Address - Phone:216-226-2721
Mailing Address - Fax:216-226-2731
Practice Address - Street 1:14650 DETROIT AVENUE
Practice Address - Street 2:SUITE LL40
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-226-2721
Practice Address - Fax:216-226-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3760103TA0400X
OH071029101Y00000X
OHI0031096101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3029252Medicaid