Provider Demographics
NPI:1508009507
Name:LIFESTYLE EAP - A DIVISION OF CLEVELAND CLINIC WELLNESS ENTERPRISE LLC
Entity Type:Organization
Organization Name:LIFESTYLE EAP - A DIVISION OF CLEVELAND CLINIC WELLNESS ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:216-297-8174
Mailing Address - Street 1:1950 RICHMOND RD
Mailing Address - Street 2:TR311
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3719
Mailing Address - Country:US
Mailing Address - Phone:216-297-8170
Mailing Address - Fax:216-297-8175
Practice Address - Street 1:1950 RICHMOND RD
Practice Address - Street 2:TR311
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-3719
Practice Address - Country:US
Practice Address - Phone:216-297-8170
Practice Address - Fax:216-297-8175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEVELAND CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE227101Y00000X
OHE268101Y00000X
OHC-0700043101Y00000X
OHE1894101Y00000X
OHC7079101Y00000X
OHE3566101Y00000X
OHE1969101Y00000X
OHE8382101Y00000X
OHI37701041C0700X
OHI22971041C0700X
OHI25731041C0700X
OHI95011041C0700X
OHI17651041C0700X
OHI6001231041C0700X
OHI73331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty