Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3258 | OH |
Y | 103TC0700X | Clinical Psychologist | 3258 | OH |
NPI | 1003991274 |
---|---|
Provider Name | Dr. James Lewis Pretzer |
First Address | Beachwood, OH 44122-6027 |
Second Address | Beachwood, OH 44122-6027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0574623 | (05) | OH |
34-1753069 | TAX ID # - BEHAVIORAL HEA (01) | OH |
PRCP10001 | (02) | OH |