Healthcare Provider Details

I. General information

NPI: 1407537871
Provider Name (Legal Business Name): UPSTAR MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5813 MAYFIELD RD STE 203
MAYFIELD HEIGHTS OH
44124-2937
US

IV. Provider business mailing address

5813 MAYFIELD RD STE 203
MAYFIELD HEIGHTS OH
44124-2937
US

V. Phone/Fax

Practice location:
  • Phone: 216-401-6564
  • Fax:
Mailing address:
  • Phone: 216-401-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: YAHAIRA MASON
Title or Position: CEO
Credential:
Phone: 216-401-6564