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General NPI Number Information
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NPI Number | 1326635475
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Entity Type | Organization
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Legal Business Name | PROJECT LIFT BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 4415 EUCLID AVE STE 315
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City | CLEVELAND
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State | OH
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Zip | 44103-3759
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Country | US
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Telephone | 216-789-0942
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Fax | 216-918-4308
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Provider Business Mailing Address
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Address Line | 4415 EUCLID AVE STE 315
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City | CLEVELAND
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State | OH
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Zip | 44103-3759
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Country | US
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Telephone | 216-789-0942
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Fax | 216-918-4308
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LATOYA LOGAN
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Credential | MSSA LISW-S
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Telephone | 216-789-0942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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