Provider Demographics
NPI:1790176477
Name:MCHUGH, ELIZABETH MEATHE (LSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MEATHE
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9810 RAVENNA ROAD
Mailing Address - Street 2:SECOND FLOOR, ROOM #1
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087
Mailing Address - Country:US
Mailing Address - Phone:440-773-8802
Mailing Address - Fax:303-331-2188
Practice Address - Street 1:9810 RAVENNA ROAD
Practice Address - Street 2:SECOND FLOOR ROOM #1
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087
Practice Address - Country:US
Practice Address - Phone:440-773-8802
Practice Address - Fax:330-331-2188
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1302747101YA0400X, 101YM0800X
OH141084101YA0400X
OHI.1501440-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2374229Medicaid