Individual
KEVIN STALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
8411 BROADWAY AVE, CLEVELAND, OH 44105-3932
(216) 206-5201
(216) 441-3637
Mailing address
8411 BROADWAY AVE, CLEVELAND, OH 44105-3932
(216) 206-5201
(216) 441-3637
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C.1500314
OH
Other
Enumeration date
08/25/2016
Last updated
08/25/2016
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