Kicos Wellness Center, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

KICOS WELLNESS CENTER, INC.

Practice address

2823 Aaronwood Ave NE Ste a
Massillon, OH 44646-2371

Phone

(330) 880-4888

NPI assigned

Jul 4, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Char Lynn Kicos, PMHNP-BC

Title

President/Ceo

Phone

(330) 880-4888

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1625356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625356800000",
    "number": "1093386732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2823 AARONWOOD AVE NE STE A",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446462371",
            "telephone_number": "330-880-4888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 AARONWOOD AVE NE STE A",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446462371",
            "telephone_number": "330-880-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICOS WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-04",
        "last_updated": "2021-07-04",
        "certification_date": "2021-07-04",
        "status": "A",
        "authorized_official_last_name": "KICOS",
        "authorized_official_first_name": "CHAR",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "330-880-4888",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0376111",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ckicos@kicoswellnesscenter.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2823 Aaronwood Ave NE Ste A",
            "city": "Massillon",
            "state": "OH",
            "country_code": "US",
            "postal_code": "446462371",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hallie Kester
• Taylor Layne Kettering, APRN
• Delishia Dene Keys
• Julia Elizabeth Kiba, LPN
• Samantha Kibler, PA
• Connie Marie Kiefer
• Paula Kimble
• Marilyn Payne Kimbrel, LPCC
• Kingnaps Inc
• Kristine A Kingsbury, R.PH.

• Community/Behavioral Health Agency in Massillon, OH
• Providers in Massillon, OH by specialty
• Community/Behavioral Health Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2021; 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.