Provider Demographics
NPI:1679140040
Name:THE BLACK MENTAL HEALTH CORPORATION
Entity Type:Organization
Organization Name:THE BLACK MENTAL HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:YANAMAYU
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:330-518-4863
Mailing Address - Street 1:4531 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3929
Mailing Address - Country:US
Mailing Address - Phone:330-518-4863
Mailing Address - Fax:216-370-3192
Practice Address - Street 1:13110 SHAKER SQ STE C200
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2373
Practice Address - Country:US
Practice Address - Phone:216-512-0321
Practice Address - Fax:216-370-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0443172Medicaid