Organization
SHAKER HEIGHTS YOUTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN JAMES LISY LISW,LPCC,LICDC,OCPS (EXECUTIVE DIRECTOR)
(216) 752-9292
Entity
Organization
Contact information
Practice address
17300 VAN AKEN BLVD, SHAKER HEIGHTS, OH 44120-3460
(216) 752-9292
(216) 752-7217
Mailing address
17300 VAN AKEN BLVD, SHAKER HEIGHTS, OH 44120-3460
(216) 752-9292
(216) 752-7217
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01081
ODADAS UPI
OH
Enumeration date
04/14/2006
Last updated
08/22/2020
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