Healthcare Provider Details

I. General information

NPI: 1992290258
Provider Name (Legal Business Name): JANET SPRUILL CMHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 LEE BLVD STE 107
CLEVELAND HEIGHTS OH
44118
US

IV. Provider business mailing address

10095 WASHINGTON BLVD N APT 102
LAUREL MD
20723-1950
US

V. Phone/Fax

Practice location:
  • Phone: 216-600-5194
  • Fax:
Mailing address:
  • Phone: 919-780-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: