Healthcare Provider Details

I. General information

NPI: 1235554825
Provider Name (Legal Business Name): JENNIFER MEWHINNEY PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY RD MEDICAL ARTS BUILDING I, SUITE 404
CLEVELAND OH
44130-3483
US

IV. Provider business mailing address

6785 MIDDLEBROOK BLVD
CLEVELAND OH
44130-2651
US

V. Phone/Fax

Practice location:
  • Phone: 440-234-8746
  • Fax:
Mailing address:
  • Phone: 440-234-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1100285
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: