# OHIO BEHAVIORAL WELLNESS AGENCY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972100139
- **Authorized official:** MR. JEFFREY G WARD LSW, LICDC-CS (PRESIDENT/CEO)
- **Authorized official phone:** (216) 798-7177

## Contact information

- **Practice address:** 12805 REVERE AVE, CLEVELAND, OH 44105-2959
- **Practice address phone:** (216) 798-7177
- **Mailing address:** 12805 REVERE AVE, CLEVELAND, OH 44105-2959
- **Mailing address phone:** (216) 798-7177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 10/01/2020
- **Last updated:** 10/07/2020