Healthcare Provider Details

I. General information

NPI: 1265994982
Provider Name (Legal Business Name): GENESIS BEHAVIORAL SERVICES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25701 N LAKELAND BLVD STE 403
EUCLID OH
44132-2453
US

IV. Provider business mailing address

25701 N LAKELAND BLVD STE 403
EUCLID OH
44132-2453
US

V. Phone/Fax

Practice location:
  • Phone: 949-500-3155
  • Fax:
Mailing address:
  • Phone: 216-273-7000
  • Fax: 216-273-7371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NABIL ABOURICHE
Title or Position: PRESIDENT
Credential:
Phone: 216-273-7000