| Life Bridge Therapy Services Llc | |
|
5010 Mayfield Rd Ste 210 Lyndhurst OH 44124-2692 | |
| (216) 533-2614 | |
| Not Available |
| Full Name | Life Bridge Therapy Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 5010 Mayfield Rd Ste 210, Lyndhurst, Ohio |
| Authorized Official Name and Position | Kelvette Beacham (FOUNDER) |
| Authorized Official Contact | 2165332614 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Bridge Therapy Services Llc 26151 Lake Shore Blvd Apt 1409 Euclid OH 44132-1156 Ph: (216) 533-2614 | Life Bridge Therapy Services Llc 5010 Mayfield Rd Ste 210 Lyndhurst OH 44124-2692 Ph: (216) 533-2614 |
| NPI Number | 1811510308 |
|---|---|
| Provider Enumeration Date | 05/19/2020 |
| Last Update Date | 07/25/2022 |
| Certification Date | 07/25/2022 |
| Medicare PECOS PAC ID | 2668891847 |
|---|---|
| Medicare Enrollment ID | O20201008000325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811510308 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kelvette Beacham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497097125 PECOS PAC ID: 1850701004 Enrollment ID: I20201029002222 |
| Provider Name | Yaasmeen Ibrahim |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003515149 PECOS PAC ID: 3375909203 Enrollment ID: I20230519001135 |
| Provider Name | Alafia Parker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730664574 PECOS PAC ID: 3476915026 Enrollment ID: I20230814001587 |
| Provider Name | Kristen Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043798481 PECOS PAC ID: 5092167403 Enrollment ID: I20240122003689 |
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