Healthcare Provider Details

I. General information

NPI: 1760298822
Provider Name (Legal Business Name): TYLER BURTON QMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13422 KINSMAN RD
CLEVELAND OH
44120-4410
US

IV. Provider business mailing address

13422 KINSMAN RD
CLEVELAND OH
44120-4410
US

V. Phone/Fax

Practice location:
  • Phone: 216-283-4400
  • Fax: 216-283-5359
Mailing address:
  • Phone: 216-283-4400
  • Fax: 216-283-5359

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: