Individual provider Active NPI

Anthony J Rudlosky, LPCC

  • Counselor
  • Medina, OH
National Provider Identifier
1912191297
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
1621 Medina Rd
Medina, OH 44256-5333
Phone
(330) 241-4444
NPI assigned
Aug 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X E.0700358 OH
Counselor 101Y00000X Primary

Addresses

Primary practice location

1621 Medina Rd
Medina, OH 44256-5333

Mailing address

1621 Medina Rd
Medina, OH 44256-5333
Phone (330) 241-4444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240409003718 OH Practitioner - Mental Health Counselor 1456799469 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E.0700358OHMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Coleman Professional Services, Inc. Mental Health CurrentSince Apr 2, 2024 Accepting new patients

Locations

400 Tuscarawas St W
Ste 200
Canton, OH 44702
Phone (330) 438-1724

5982 Rhodes Rd
Kent, OH 44240
Phone (330) 676-6875

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.

NPI Registry JSON

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1912191297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 MEDINA RD",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442565333",
            "telephone_number": "330-241-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 MEDINA RD",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442565333",
            "telephone_number": "330-241-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDLOSKY",
        "first_name": "ANTHONY",
        "middle_name": "J",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-30",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.0700358",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, OH

Sources for this page

Verify at the official NPI Registry.