MEDICARE: OUTLAND BEHAVIORAL HEALTH

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

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	:	1497485122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTLAND BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	5934 HODGMAN DR
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-2153
Country	:	US
Telephone Number	:	216-407-7108
Fax Number	:	216-359-3646

Provider Business Practice Location Address
First Line	:	5934 HODGMAN DR
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-2153
Country	:	US
Telephone Number	:	216-407-7108
Fax Number	:	216-359-3646

Authorized Official
Title or Position	:	LICENSED COUNSELOR SUPERVISOR
Name	:	MS. JENNIFER MARIE OUTLAND
Credential	:	MSED, LPCC-S
Telephone Number	:	216-407-7108

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	03/06/2024

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Directions to “OUTLAND BEHAVIORAL HEALTH ” Practice Location

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