Healthcare Provider Details

I. General information

NPI: 1205606399
Provider Name (Legal Business Name): MERCEDES HURT QBHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 SHAKER BLVD STE 301
CLEVELAND OH
44120-1927
US

IV. Provider business mailing address

11201 SHAKER BLVD STE 200
CLEVELAND OH
44104-3869
US

V. Phone/Fax

Practice location:
  • Phone: 216-273-7073
  • Fax:
Mailing address:
  • Phone: 216-273-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: