Healthcare Provider Details

I. General information

NPI: 1467916809
Provider Name (Legal Business Name): INTER-CEPT CONSULTANT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13303 BEACHWOOD AVE
CLEVELAND OH
44105-6415
US

IV. Provider business mailing address

13303 BEACHWOOD AVE
CLEVELAND OH
44105-6415
US

V. Phone/Fax

Practice location:
  • Phone: 216-581-1662
  • Fax: 216-581-4540
Mailing address:
  • Phone: 216-581-1662
  • Fax: 216-581-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA MILLER
Title or Position: CEO
Credential: LICDC-CS
Phone: 216-402-0684