MEDICARE: JACQUELINE MEHTA CT

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	101YP2500X	Professional Counselor	C.2506930	OH

General Provider Information

NPI Number	:	1568219194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MEHTA CT

Provider Business Mailing Address
First Line	:	13201 GRANGER RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-1978
Country	:	US
Telephone Number	:	216-831-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	13201 GRANGER RD
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-1978
Country	:	US
Telephone Number	:	216-831-2255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	04/08/2025

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Directions to “ JACQUELINE MEHTA CT” Practice Location

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