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General NPI Number Information
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NPI Number | 1679140040
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Entity Type | Organization
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Legal Business Name | THE BLACK MENTAL HEALTH CORPORATION
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Dates
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Enumeration Date | 06/05/2021
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Last Update Date | 06/05/2021
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Provider Practice Location Address
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Address Line | 13110 SHAKER SQ STE C200
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City | CLEVELAND
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State | OH
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Zip | 44120-2373
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Country | US
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Telephone | 216-512-0321
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Fax | 216-370-3192
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Provider Business Mailing Address
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Address Line | 4531 EMERSON RD
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City | SOUTH EUCLID
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State | OH
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Zip | 44121-3929
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Country | US
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Telephone | 330-518-4863
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Fax | 216-370-3192
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. DESMOND EUGENE YANAMAYU
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Credential | LISW-S
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Telephone | 330-518-4863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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