Individual
STEPHANIE L KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, MED, LPCC/PCC
Contact information
Practice address
6929 W 130TH ST, SUITE 503, CLEVELAND, OH 44130-7895
(440) 481-3055
(440) 481-3222
Mailing address
6929 W 130TH ST, SUITE 503, CLEVELAND, OH 44130-7895
(440) 481-3055
(440) 481-3222
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
E0007819
OH
101YP2500X
Professional Counselor
E0007819
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2908413
UHC/UBH PROVIDER ID
OH
05
—
2967384
—
OH
01
—
393335
PROVIDER MHN (HEALTHNET) ID#
OH
01
—
587502
PROVIDER VO ID#
OH
Enumeration date
10/16/2006
Last updated
10/23/2014
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