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NPI Code Detail

MEDICARE: A SAFE PLACE MENTAL HEALTH COUNSELING SERVICES

MEDICARE: A SAFE PLACE MENTAL HEALTH COUNSELING SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency0600269OH
2251S00000XCommunity/Behavioral Health Agency0600269OH

General Provider Information

NPI Number : 1043569866
Entity Type Code : Organization
Provider Name (Legal Business Name) : A SAFE PLACE MENTAL HEALTH COUNSELING SERVICES
Provider Business Mailing Address
First Line : 30841 EUCLID AVE
Second Line :
City : WILLOUGHBY
State : OH
Zip : 44094-3100
Country : US
Telephone Number : 440-516-0281
Fax Number : 440-516-0281
Provider Business Practice Location Address
First Line : 30841 EUCLID AVE
Second Line :
City : WILLOUGHBY
State : OH
Zip : 44094-3100
Country : US
Telephone Number : 440-516-0281
Fax Number : 440-516-0281
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : KIMBERLY ANN ANDREWS
Credential : PC
Telephone Number : 216-310-8471
Provider Enumeration Date : 09/07/2012
Last Update Date : 09/07/2012

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