Healthcare Provider Details

I. General information

NPI: 1831928738
Provider Name (Legal Business Name): JALINA MARIE LOCKHART MSSHB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14315 CORRIDON AVE
MAPLE HEIGHTS OH
44137-3230
US

IV. Provider business mailing address

14315 CORRIDON AVE
MAPLE HEIGHTS OH
44137-3230
US

V. Phone/Fax

Practice location:
  • Phone: 216-551-5551
  • Fax:
Mailing address:
  • Phone: 216-551-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPS.005318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: