Healthcare Provider Details

I. General information

NPI: 1437994209
Provider Name (Legal Business Name): ALLISON GRACE MAHRER QMHS-B
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 EUCLID AVE
CLEVELAND OH
44106-4310
US

IV. Provider business mailing address

2223 WARREN RD
LAKEWOOD OH
44107-5936
US

V. Phone/Fax

Practice location:
  • Phone: 216-721-4010
  • Fax:
Mailing address:
  • Phone: 440-665-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: