1457193732 NPI number — ONE STOP MENTAL HEALTH CLINIC LLC

Table of content: (NPI 1457193732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457193732 NPI number — ONE STOP MENTAL HEALTH CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE STOP MENTAL HEALTH CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457193732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27050 CEDAR RD
Provider Second Line Business Mailing Address:
BLDG 4 APT 506
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-1125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-799-2217
Provider Business Mailing Address Fax Number:
216-377-4719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17407 HARVARD RD
Provider Second Line Business Practice Location Address:
DOWN
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44128-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-377-4719
Provider Business Practice Location Address Fax Number:
216-200-8376
Provider Enumeration Date:
06/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
ONUNAKU
Authorized Official First Name:
FRANCISCA
Authorized Official Middle Name:
U
Authorized Official Title or Position:
NURSE PRACTIONER-OWNER-ONE STOP MEN
Authorized Official Telephone Number:
216-799-2217

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0380852 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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