Provider Demographics
NPI:1720695943
Name:ELEVEN 11 BEHAVIORAL SOLUTIONS
Entity type:Organization
Organization Name:ELEVEN 11 BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMBERLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA, COBA
Authorized Official - Phone:216-870-6089
Mailing Address - Street 1:2993 SAND DOLLAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7724
Mailing Address - Country:US
Mailing Address - Phone:216-870-6089
Mailing Address - Fax:
Practice Address - Street 1:2993 SAND DOLLAR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7724
Practice Address - Country:US
Practice Address - Phone:216-870-6089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health