| The Black Mental Health Corporation | |
|
13110 Shaker Sq Ste C200-f Cleveland OH 44120-2373 | |
| (216) 512-0321 | |
| Not Available |
| Full Name | The Black Mental Health Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 13110 Shaker Sq Ste C200-f, Cleveland, Ohio |
| Authorized Official Name and Position | Desmond Yanamayu (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2165120321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Black Mental Health Corporation 4531 Emerson Rd South Euclid OH 44121-3929 Ph: (330) 518-4863 | The Black Mental Health Corporation 13110 Shaker Sq Ste C200-f Cleveland OH 44120-2373 Ph: (216) 512-0321 |
| NPI Number | 1679053664 |
|---|---|
| Provider Enumeration Date | 08/18/2018 |
| Last Update Date | 03/30/2020 |
| Certification Date | 03/30/2020 |
| Medicare PECOS PAC ID | 1951730290 |
|---|---|
| Medicare Enrollment ID | O20200407002852 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679053664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Desmond Eugene Yanamayu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437403698 PECOS PAC ID: 9830487487 Enrollment ID: I20161013001885 |
| Provider Name | Shannelle Lockhart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972264828 PECOS PAC ID: 7517340979 Enrollment ID: I20220817002000 |
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