Provider Demographics
NPI:1629520754
Name:THE PAST PROJECT
Entity Type:Organization
Organization Name:THE PAST PROJECT
Other - Org Name:PREVAILING AND SURVIVING TOGETHER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT - EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-404-9243
Mailing Address - Street 1:5303 NORTHFIELD RD APT 505
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1116
Mailing Address - Country:US
Mailing Address - Phone:216-404-9243
Mailing Address - Fax:
Practice Address - Street 1:16254 LIBBY RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1222
Practice Address - Country:US
Practice Address - Phone:216-338-7907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1.1302427251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health