Provider Demographics
NPI:1306309232
Name:MALE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:MALE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LISW
Authorized Official - Phone:216-224-5472
Mailing Address - Street 1:1298 CRYSTAL TREE CT
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8247
Mailing Address - Country:US
Mailing Address - Phone:216-224-5472
Mailing Address - Fax:
Practice Address - Street 1:1298 CRYSTAL TREE CT
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8247
Practice Address - Country:US
Practice Address - Phone:614-454-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health