Basic Information
| Provider Information | |||||||||
| NPI: | 1124406715 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR EFFECTIVE LIVING INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9286 PROVINCE LN | ||||||||
| Address2: | |||||||||
| City: | BRECKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441411781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162109951 | ||||||||
| FaxNumber: | 4407179595 | ||||||||
| Practice Location | |||||||||
| Address1: | 20800 CENTER RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441164312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403334949 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2015 | ||||||||
| LastUpdateDate: | 05/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | KORICKE | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4403334949 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | C.0602079 | OH | Y | Agencies | Community/Behavioral Health |
No ID Information.