Provider Demographics
NPI:1629779202
Name:CSEH, MICHELLE KYLA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KYLA
Last Name:CSEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KYLA
Other - Last Name:MAXIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:565 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2409
Mailing Address - Country:US
Mailing Address - Phone:440-897-8567
Mailing Address - Fax:
Practice Address - Street 1:2460 FAIRMOUNT BLVD STE 206
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3125
Practice Address - Country:US
Practice Address - Phone:216-273-3921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2302892-TRNE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker