MEDICARE: PROJECT LIFT BEHAVIORAL HEALTH 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
1	1041C0700X	Clinical Social Worker
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326635475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT LIFT BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	4415 EUCLID AVE STE 315
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3759
Country	:	US
Telephone Number	:	216-789-0942
Fax Number	:	216-918-4308

Provider Business Practice Location Address
First Line	:	4415 EUCLID AVE STE 315
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3759
Country	:	US
Telephone Number	:	216-789-0942
Fax Number	:	216-918-4308

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LATOYA LOGAN
Credential	:	MSSA LISW-S
Telephone Number	:	216-789-0942

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	08/02/2021

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