Provider Demographics
NPI:1457579005
Name:LOOKING FORWARD MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:LOOKING FORWARD MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEUDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-651-0234
Mailing Address - Street 1:1891 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113
Mailing Address - Country:US
Mailing Address - Phone:216-651-0234
Mailing Address - Fax:216-651-1096
Practice Address - Street 1:1891 FULTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113
Practice Address - Country:US
Practice Address - Phone:216-651-0234
Practice Address - Fax:216-651-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003190101Y00000X
OH975961101YA0400X
OHI0009423101YM0800X
OH47942106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7310587OtherAETNA
OHDD8865OtherRAIL ROAD
OH=========00OtherWORKERS COMP
OH9345261Medicare ID - Type Unspecified