Healthcare Provider Details

I. General information

NPI: 1972020790
Provider Name (Legal Business Name): JESSIE ALLAN LEU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 LORAIN AVE STE 407
CLEVELAND OH
44113-3726
US

IV. Provider business mailing address

9399 BASSWOOD DR
OLMSTED FALLS OH
44138-2577
US

V. Phone/Fax

Practice location:
  • Phone: 216-250-1607
  • Fax: 216-304-6669
Mailing address:
  • Phone: 330-554-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number163042
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2303972
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: