# BE HEALED FAMILY OUTREACH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Success 1 Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184824344
- **Authorized official:** MR. MIN. JEROME C. RIVERS LPCC-S, LIMFT, CCDC1 (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (216) 224-4254

## Contact information

- **Practice address:** 670 BROADWAY AVE, BEDFORD, OH 44146-3642
- **Practice address phone:** (440) 439-9250
- **Practice address fax:** (216) 641-7330
- **Mailing address:** 670 BROADWAY AVE, BEDFORD, OH 44146-3642
- **Mailing address phone:** (440) 439-9250
- **Mailing address fax:** (216) 641-7330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 011102 | OH | — |
| 101YP1600X | Pastoral Counselor | E4292 | OH | — |
| 101YP2500X | Professional Counselor | E4292 | OH | — |
| 106H00000X | Marriage & Family Therapist | F120 | OH | Yes |

## Other

- **Enumeration date:** 07/24/2007
- **Last updated:** 07/24/2007