Provider Demographics
NPI:1861597148
Name:NEW HORIZONS PSYCHIATRIC COUNSELING AND PAIN MANAGEMENT SERVICES LLC
Entity type:Organization
Organization Name:NEW HORIZONS PSYCHIATRIC COUNSELING AND PAIN MANAGEMENT SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IKEMEFUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NKANGINIEME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-493-9822
Mailing Address - Street 1:4735 BELPAR ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3648
Mailing Address - Country:US
Mailing Address - Phone:330-493-9822
Mailing Address - Fax:330-493-9816
Practice Address - Street 1:4735 BELPAR ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3648
Practice Address - Country:US
Practice Address - Phone:330-493-9822
Practice Address - Fax:330-493-9816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE9353621Medicare ID - Type Unspecified