NPIMap

Organization Active NPI

KSK Health Services LLC

  • Psychiatry Physician
  • Parma Heights, OH
National Provider Identifier
1033409222
Registry record updated Dec 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
35060650 Issued in OH
Legal business name
KSK HEALTH SERVICES LLC
Practice address
6929 W 130TH St
Suite 503
Parma Heights, OH 44130-7895
Phone
(440) 481-3055
Fax
(440) 481-3222
NPI assigned
Apr 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephanie L Kidd, LPCC/PCCNPI 1801976634
Title
Manager/Ceo
Phone
(440) 481-3055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X E0004052 OH
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X E0900389 OH
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X E0007819 OH
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 6890 OH
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X I0007634 OH
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 35099315 OH
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 35060650 OH Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X 35060650 OH

Addresses

Primary practice location

6929 W 130TH St
Suite 503
Parma Heights, OH 44130-7895

Mailing address

6929 W 130TH St
Suite 503
Parma Heights, OH 44130-7895
Phone (440) 481-3055

Other identifiers 13

IdentifierTypeStateIssuer
12634224OtherOHPROVIDER CAQH #
3349058OtherOHUHC/UBH PROVIDER ID
393335OtherOHPROVIDER MHN (HEALTHNET) ID#
687211OtherOHVO GROUP PROVIDER ID#
11744590OtherOHPROVIDER CAQH #
12638930OtherOHPROVIDER CAQH #
0051324MedicaidOH
587502OtherOHPROVIDER VO ID#
0084596MedicaidOH
11753827OtherOHPROVIDER CAQH #
2967384MedicaidOH
687211OtherOHVO MILITARY ONE GROUP PROVIDER ID#
2908413OtherOHPROVIDER UHC/UBH ID#

National Provider Directory

National Provider Directory

Locations

50 Pearl Rd
Ste 104
Brunswick, OH 44212
Phone (440) 239-5650

7530 Lucerne Dr
Ste 208
Middleburg Heights, OH 44130
Phone (440) 239-5950

6929 W 130th St
Ste 503
Parma Heights, OH 44130
Phone (440) 239-5950

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418342400000",
    "number": "1033409222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6929 W 130TH ST",
            "address_2": "SUITE 503",
            "city": "PARMA HEIGHTS",
            "state": "OH",
            "postal_code": "441307895",
            "telephone_number": "440-481-3055",
            "fax_number": "440-481-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6929 W 130TH ST",
            "address_2": "SUITE 503",
            "city": "PARMA HEIGHTS",
            "state": "OH",
            "postal_code": "441307895",
            "telephone_number": "440-481-3055",
            "fax_number": "440-481-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSK HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-09",
        "last_updated": "2014-12-12",
        "status": "A",
        "authorized_official_last_name": "KIDD",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER/CEO",
        "authorized_official_telephone_number": "440-481-3055",
        "authorized_official_credential": "LPCC/PCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E0004052",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E0900389",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E0007819",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "6890",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I0007634",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35099315",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35060650",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "OH",
            "license": "35060650",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER CAQH #",
            "identifier": "12634224",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC/UBH PROVIDER ID",
            "identifier": "3349058",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER MHN (HEALTHNET) ID#",
            "identifier": "393335",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VO GROUP PROVIDER ID#",
            "identifier": "687211",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER CAQH #",
            "identifier": "11744590",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER CAQH #",
            "identifier": "12638930",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0051324",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER VO ID#",
            "identifier": "587502",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0084596",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER CAQH #",
            "identifier": "11753827",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2967384",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VO MILITARY ONE GROUP PROVIDER ID#",
            "identifier": "687211",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER UHC/UBH ID#",
            "identifier": "2908413",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Parma Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.