Active NPI
Jake Protivnak, PC
- Counselor
- Ravenna, OH
National Provider Identifier
1689889156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- C7727
- Practice address
- 3920 Lovers LN
Ravenna, OH 44266-4200 - Phone
- (330) 673-1347
- Fax
- (330) 678-3677
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | C7727 | OH | Primary |
Addresses
Primary practice location
3920 Lovers LN
Ravenna, OH 44266-4200
Mailing address
5982 Rhodes Rd
Kent, OH 44240-4128
Phone (330) 673-1347
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C7727 | OH | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coleman Professional Services, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- Kent, OH
- NPI 1982637633
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689889156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5982 RHODES RD",
"city": "KENT",
"state": "OH",
"postal_code": "442404128",
"telephone_number": "330-673-1347",
"fax_number": "330-678-3677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3920 LOVERS LN",
"city": "RAVENNA",
"state": "OH",
"postal_code": "442664200",
"telephone_number": "330-673-1347",
"fax_number": "330-678-3677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROTIVNAK",
"first_name": "JAKE",
"credential": "PC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OH",
"license": "C7727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ravenna, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.