Healthcare Provider Details

I. General information

NPI: 1578476040
Provider Name (Legal Business Name): INEZ HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 MENTOR AVE
MENTOR OH
44060-6412
US

IV. Provider business mailing address

401 LEE RD APT 8
BEDFORD OH
44146-7324
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-1700
  • Fax:
Mailing address:
  • Phone: 216-414-1074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: