Provider Demographics
NPI:1912643750
Name:TEAM COUTURE BEHAVIORAL HEALTH SERVICE
Entity Type:Organization
Organization Name:TEAM COUTURE BEHAVIORAL HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MPA
Authorized Official - Phone:216-785-9244
Mailing Address - Street 1:4143 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3042
Mailing Address - Country:US
Mailing Address - Phone:216-785-9244
Mailing Address - Fax:
Practice Address - Street 1:4143 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3042
Practice Address - Country:US
Practice Address - Phone:216-785-9244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty