Healthcare Provider Details

I. General information

NPI: 1942719174
Provider Name (Legal Business Name): RAHEEM TYUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9083 MENTOR AVE
MENTOR OH
44060-6462
US

IV. Provider business mailing address

9083 MENTOR AVE
MENTOR OH
44060-6462
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-0678
  • Fax: 440-255-6348
Mailing address:
  • Phone: 440-255-0678
  • Fax: 440-255-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number164558
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: