Healthcare Provider Details

I. General information

NPI: 1255930467
Provider Name (Legal Business Name): JESSICA BECKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20620 JOHN CARROLL BLVD STE 214
UNIVERSITY HEIGHTS OH
44118-4540
US

IV. Provider business mailing address

1357 W 59TH ST
CLEVELAND OH
44102-2101
US

V. Phone/Fax

Practice location:
  • Phone: 216-408-7555
  • Fax: 216-424-3239
Mailing address:
  • Phone: 440-622-4444
  • Fax: 216-424-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA BECKA
Title or Position: OWNER/EMPLOYEE
Credential:
Phone: 440-622-7444