Provider Demographics
NPI:1497485122
Name:OUTLAND BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:OUTLAND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED COUNSELOR SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OUTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, LPCC-S
Authorized Official - Phone:216-407-7108
Mailing Address - Street 1:5934 HODGMAN DR
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-2153
Mailing Address - Country:US
Mailing Address - Phone:216-407-7108
Mailing Address - Fax:216-359-3646
Practice Address - Street 1:5934 HODGMAN DR
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-2153
Practice Address - Country:US
Practice Address - Phone:216-407-7108
Practice Address - Fax:216-359-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1184117673Medicaid