Healthcare Provider Details

I. General information

NPI: 1962134031
Provider Name (Legal Business Name): RAY MCCLOUD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22070 LAKE SHORE BLVD APT 4
CLEVELAND OH
44123-1745
US

IV. Provider business mailing address

22070 LAKE SHORE BLVD APT 4
EUCLID OH
44123-1745
US

V. Phone/Fax

Practice location:
  • Phone: 216-304-9864
  • Fax:
Mailing address:
  • Phone: 216-304-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193336
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: