Provider Demographics
NPI:1225666910
Name:TAPP, JUSTIN (CDCA, QMHS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:TAPP
Suffix:
Gender:M
Credentials:CDCA, QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3891
Mailing Address - Country:US
Mailing Address - Phone:440-233-7232
Mailing Address - Fax:440-204-4315
Practice Address - Street 1:6140 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3891
Practice Address - Country:US
Practice Address - Phone:440-233-7232
Practice Address - Fax:440-204-4315
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2022-01-25
Deactivation Date:2021-06-22
Deactivation Code:
Reactivation Date:2021-07-13
Provider Licenses
StateLicense IDTaxonomies
OH179607101YA0400X
171M00000X
OH2102198104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator