Provider Demographics
NPI:1720313638
Name:PICKARD, ROBERT DARRELL SR (LPCC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DARRELL
Last Name:PICKARD
Suffix:SR
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 S BELVOIR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2348
Mailing Address - Country:US
Mailing Address - Phone:216-531-9580
Mailing Address - Fax:216-531-9581
Practice Address - Street 1:10427 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1645
Practice Address - Country:US
Practice Address - Phone:216-694-7200
Practice Address - Fax:216-521-6006
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0800106101YP2500X
OHE.0800106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health