Healthcare Provider Details

I. General information

NPI: 1609460880
Provider Name (Legal Business Name): POSITIVE STEPS CONSULTING AND PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2021
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SEVERANCE CIR STE 802
CLEVELAND HEIGHTS OH
44118-1592
US

IV. Provider business mailing address

1924 REVERE RD
CLEVELAND HEIGHTS OH
44118-2234
US

V. Phone/Fax

Practice location:
  • Phone: 216-399-3130
  • Fax:
Mailing address:
  • Phone: 952-807-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. OTIMBUM L WILSON JR.
Title or Position: OWNER/ CLINICAL DIRECTOR
Credential: LPCC
Phone: 216-399-3130