Provider Demographics
NPI:1497097125
Name:BEACHAM, KELVETTE (LISW)
Entity Type:Individual
Prefix:
First Name:KELVETTE
Middle Name:
Last Name:BEACHAM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26151 LAKE SHORE BLVD APT 1409W
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1156
Mailing Address - Country:US
Mailing Address - Phone:216-533-2614
Mailing Address - Fax:
Practice Address - Street 1:5010 MAYFIELD RD STE 210
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2692
Practice Address - Country:US
Practice Address - Phone:216-831-2255
Practice Address - Fax:216-378-3906
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.09014151041C0700X
OHL15005241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871101Medicaid