Basic Information
| Provider Information | |||||||||
| NPI: | 1720313638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PICKARD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | DARRELL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 S BELVOIR BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTH EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441212348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165319580 | ||||||||
| FaxNumber: | 2165319581 | ||||||||
| Practice Location | |||||||||
| Address1: | 10427 DETROIT AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441021645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2166947200 | ||||||||
| FaxNumber: | 2165216006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2009 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C 0800106 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | E.0800106 | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.