MEDICARE: JUSTIN OTTIS MACK QMHS, CDCA,BA

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	176595	OH
2	171M00000X	Case Manager/Care Coordinator	UH804004	OH

General Provider Information

NPI Number	:	1508472952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN OTTIS MACK QMHS, CDCA,BA

Provider Business Mailing Address
First Line	:	2151 W 81ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4162
Country	:	US
Telephone Number	:	716-446-3944
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W 81ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4162
Country	:	US
Telephone Number	:	716-446-3944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	06/17/2024

Similar Medicare Providers

1629374392 — MONEEKE TYLER RN
Practice Location Address:

2137 W 81ST ST
CLEVELAND, OH
44102-4162

Practice Phone: 216-926-6694
Practice Fax:

1275376352 — JUST IN TIME COMMUNITY CASE MANAGEMENT SERVICES LLC
Practice Location Address:

2151 W 81ST ST
CLEVELAND, OH
44102-4162

Practice Phone: 216-713-3831
Practice Fax:

1124599402 — CARMEN MELISSA HALL-SHORTS
Practice Location Address:

7310 CARSON AVE
CLEVELAND, OH
44104-4162

Practice Phone: 234-334-3293
Practice Fax:

1851128771 — MRS. MARIA CHAMORRO
Practice Location Address:

4162 W 57TH ST
CLEVELAND, OH
44144-1852

Practice Phone: 325-812-3646
Practice Fax:

1578178323 — STEFAN GUDZ PA-C
Practice Location Address:

3569 RIDGE RD
CLEVELAND, OH
44102-5443

Practice Phone: 216-281-0872
Practice Fax:

1487498184 — MISTURA OYEWUMI AKINWOYE
Practice Location Address:

10427 DETROIT AVE
CLEVELAND, OH
44102-1645

Practice Phone: 216-521-6511
Practice Fax: 216-521-6006

Directions to “ JUSTIN OTTIS MACK QMHS, CDCA,BA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.