Healthcare Provider Details

I. General information

NPI: 1699905687
Provider Name (Legal Business Name): JASON C. MYERS LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

2755 ERIE DR
FAIRLAWN OH
44333-3512
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax:
Mailing address:
  • Phone: 614-352-6469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number111058
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0700227
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: