Provider Demographics
NPI:1649965583
Name:CHANEY-MCCLARIN, JONTEZ
Entity type:Individual
Prefix:
First Name:JONTEZ
Middle Name:
Last Name:CHANEY-MCCLARIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4887 FARNHURST RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2355
Mailing Address - Country:US
Mailing Address - Phone:440-424-0543
Mailing Address - Fax:
Practice Address - Street 1:5 SEVERANCE CIR STE 201
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1567
Practice Address - Country:US
Practice Address - Phone:216-785-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator