Provider Demographics
NPI:1851279350
Name:LIFE EVOLUTION BEHAVIORAL HEALTHCARE INC.
Entity type:Organization
Organization Name:LIFE EVOLUTION BEHAVIORAL HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPCC
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNTONN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:216-633-2505
Mailing Address - Street 1:2269 GRANDVIEW AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3179
Mailing Address - Country:US
Mailing Address - Phone:216-633-2505
Mailing Address - Fax:
Practice Address - Street 1:2269 GRANDVIEW AVE APT 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3179
Practice Address - Country:US
Practice Address - Phone:216-633-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty