Healthcare Provider Details

I. General information

NPI: 1225953789
Provider Name (Legal Business Name): ROCKSTAR BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 E 108TH ST
CLEVELAND OH
44108-1435
US

IV. Provider business mailing address

529 E 108TH ST
CLEVELAND OH
44108-1435
US

V. Phone/Fax

Practice location:
  • Phone: 216-659-5433
  • Fax:
Mailing address:
  • Phone: 216-659-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE RENEE WILLIAMS
Title or Position: RN, PMHNP
Credential: WILLIAMS
Phone: 216-659-5433