Organization
KICOS WELLNESS CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHAR LYNN KICOS PMHNP-BC (PRESIDENT/CEO)
(330) 880-4888
Entity
Organization
Contact information
Practice address
2823 AARONWOOD AVE NE STE A, MASSILLON, OH 44646-2371
(330) 880-4888
Mailing address
2823 AARONWOOD AVE NE STE A, MASSILLON, OH 44646-2371
(330) 880-4888
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0376111
—
OH
Enumeration date
07/04/2021
Last updated
07/04/2021
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