Charlie Bango, LPCC-S
Individual provider Active NPI Mental Health Counselor · Lakewood, OH
NPI 1376949446 · NPPES record last updated Nov 17, 2014
Key facts
- NPI
- 1376949446
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- E2133-S (OH)
- Practice address
- 17405 Hilliard Rd
Lakewood, OH 44107-5305 - Phone
- (216) 312-4774
- NPI assigned
- Nov 17, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Behavioral Health Services of Greater Cleveland
Practice addresses (Care Compare)
20525 Ctr Ridge Rd
Suite 403
Rocky River, OH 44116-3401
Phone (216) 456-5510
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240122001226 | OH | Practitioner - Mental Health Counselor | 5294187639 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E2133-S | OH | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavioral Health Services of Greater Cleveland | Current |
Accepting new patients |
Locations
20525 Center Ridge Rd
Ste 403
Rocky River, OH 44116
Phone (216) 456-5510
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | E2133-S | OH | Yes |
Addresses
Primary practice location
17405 Hilliard Rd
Lakewood, OH 44107-5305
Mailing address
17405 Hilliard Rd
Lakewood, OH 44107
Phone (216) 312-4774
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- Emma Catherine C. Pitchford Bango
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All providers in Lakewood, OH · Mental Health Counselor in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.