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General NPI Number Information
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NPI Number | 1750291613
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Entity Type | Organization
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Legal Business Name | PROVIDER BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/11/2026
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Last Update Date | 09/11/2026
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Provider Practice Location Address
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Address Line | 15400 PEARL RD STE 238
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City | STRONGSVILLE
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State | OH
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Zip | 44136-6000
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Country | US
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Telephone | 440-879-1258
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Fax | 440-334-5403
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Provider Business Mailing Address
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Address Line | 15400 PEARL RD STE 238
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City | STRONGSVILLE
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State | OH
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Zip | 44136-6000
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Country | US
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Telephone | 440-879-1258
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Fax | 440-334-5403
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Authorized Official
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Title or Position | TAX ID OWNER
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Name | RACHEL PETRICK
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Credential | CNP
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Telephone | 440-879-1258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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