MEDICARE: VESTED MENTAL HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1538803218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VESTED MENTAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	2034 REVERE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2634
Country	:	US
Telephone Number	:	216-406-8937
Fax Number	:

Provider Business Practice Location Address
First Line	:	2034 REVERE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2634
Country	:	US
Telephone Number	:	216-406-8937
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	CERINA NICOLE WOODALL
Credential	:	MSW, LSW
Telephone Number	:	216-406-8937

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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