MEDICARE: MITCHELL DEVAN

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	175T00000X	Peer Specialist	APS.005757	OH

General Provider Information

NPI Number	:	1568353019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL DEVAN

Provider Business Mailing Address
First Line	:	5360 BROADVIEW RD STE 103
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-7804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5360 BROADVIEW RD STE 103
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-7804
Country	:	US
Telephone Number	:	216-744-4232
Fax Number	:

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

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	01/09/2026

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Directions to “ MITCHELL DEVAN ” Practice Location

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