Healthcare Provider Details

I. General information

NPI: 1083525638
Provider Name (Legal Business Name): MYGRELL COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 OAK TREE BLVD STE 200
INDEPENDENCE OH
44131-6914
US

IV. Provider business mailing address

6100 OAK TREE BLVD STE 200
INDEPENDENCE OH
44131-6914
US

V. Phone/Fax

Practice location:
  • Phone: 216-532-3389
  • Fax: 216-247-1676
Mailing address:
  • Phone: 216-532-3389
  • Fax: 216-247-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL L. DRAKE
Title or Position: OWNER
Credential: PHD
Phone: 216-532-3389