Provider Demographics
NPI:1548371032
Name:MULTIMODAL THERAPY INSTITUTE,INC
Entity type:Organization
Organization Name:MULTIMODAL THERAPY INSTITUTE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELING PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-349-5445
Mailing Address - Street 1:PO BOX 391662
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-8662
Mailing Address - Country:US
Mailing Address - Phone:440-349-5445
Mailing Address - Fax:
Practice Address - Street 1:6605 LIMBERLOST CT
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3100
Practice Address - Country:US
Practice Address - Phone:440-349-5445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2187103TA0400X, 103TS0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0320996Medicaid
OHCP07851Medicare PIN
OHR71688Medicare UPIN