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General NPI Number Information
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NPI Number | 1750027538
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Entity Type | Organization
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Legal Business Name | LIFEWORKS BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 17325 EUCLID AVE STE 3040
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City | CLEVELAND
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State | OH
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Zip | 44112-1276
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Country | US
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Telephone | 216-525-3775
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Fax |
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Provider Business Mailing Address
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Address Line | 858 ROANOKE RD
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City | CLEVELAND HEIGHTS
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State | OH
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Zip | 44121-2054
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LISA SULLIVAN
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Credential |
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Telephone | 440-453-0754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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