Healthcare Provider Details

I. General information

NPI: 1992563480
Provider Name (Legal Business Name): CLOUDY JAMILLAH MEEKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 SPRUCE ST
WOOSTER OH
44691-4678
US

IV. Provider business mailing address

608 SPRUCE ST
WOOSTER OH
44691-4678
US

V. Phone/Fax

Practice location:
  • Phone: 330-347-8712
  • Fax:
Mailing address:
  • Phone: 330-347-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: