Healthcare Provider Details

I. General information

NPI: 1760159974
Provider Name (Legal Business Name): MYKALA HOUSEBURG LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 MCCRACKEN RD STE A-UP
GARFIELD HEIGHTS OH
44125-2967
US

IV. Provider business mailing address

1650 CEDARWOOD DR APT 338
WESTLAKE OH
44145-1827
US

V. Phone/Fax

Practice location:
  • Phone: 216-587-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506794
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: