Provider Demographics
NPI:1184824344
Name:BE HEALED FAMILY OUTREACH
Entity Type:Organization
Organization Name:BE HEALED FAMILY OUTREACH
Other - Org Name:SUCCESS 1 SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIN. JEROME
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, LIMFT, CCDC1
Authorized Official - Phone:216-224-4254
Mailing Address - Street 1:670 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3642
Mailing Address - Country:US
Mailing Address - Phone:440-439-9250
Mailing Address - Fax:216-641-7330
Practice Address - Street 1:670 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3642
Practice Address - Country:US
Practice Address - Phone:440-439-9250
Practice Address - Fax:216-641-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011102101YA0400X
OHE4292101YP1600X, 101YP2500X
OHF120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty