JEFFREY JACK (NPI# 1346754124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346754124 |
| Entity Type | Individual |
| Full Name | JEFFREY JACK |
| Credential | LPC |
| Practice Address |
2801 Martin Luther King Jr Dr Cleveland OH 44104 |
| Mailing Address |
2801 Martin Luther King Jr Dr Cleveland OH 44104-3815 |
| Practice Telephone | 2164486325 |
| Mailing Telephone | 2164486325 |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2019-02-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2801 Martin Luther King Jr Dr, Cleveland, OH 44104 | 2164486325 | |
| 3929 Rocky River Dr, Cleveland, OH 441114153 | 2162525800 |
| Street Address |
2801 MARTIN LUTHER KING JR DR |
| City | CLEVELAND |
| State | OH |
| Zip Code | 44104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033161948 | Cleveland Clinic Children's Hospital for Rehabilitation | Rehabilitation Hospital | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104-3815 | 2006-05-17 |
| 1992316400 | Emilee Carmen Valler Gorfien | Psychologist | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104-3815 | 2020-08-10 |
| 1609416874 | Elizabeth Schilling | Behavioral Analyst | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104-3815 | 2020-01-15 |
| 1578070462 | Holly Ann Hennessey | Behavioral Analyst | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104-3815 | 2018-01-02 |
| 1265948970 | Chiara Marie Graver | Behavioral Analyst | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104-3815 | 2017-12-18 |
| 1992218192 | Kristen Ginty | Behavioral Analyst | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104-3815 | 2017-11-09 |
| 1942727219 | Hilary Joy Parsons Alexander | Counselor | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104-3815 | 2017-08-27 |
| 1801313218 | Melissa Andrea Tomei | Nurse Practitioner | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104 | 2017-08-25 |
| 1720470909 | Tatyana Maricic | Registered Nurse | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104-3815 | 2015-02-25 |
| 1467857375 | Laura Howk | Behavioral Analyst | 2801 Martin Luther King Jr Dr, Cleveland, OH 44104-3815 | 2014-11-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619510419 | Gwen Burtin | Technician | 9908 Kennedy Ave, Cleveland, OH 44104 | 2019-10-24 |
| 1215422001 | Julia Shneyderman | Dentist | 11202 Shaker Blvd Ste 136, Cleveland, OH 44104 | 2018-06-25 |
| 1477058527 | Kwananda A Plato | Technician | 9717 Elwell Ave., Cleveland, OH 44104 | 2018-03-29 |
| 1073035887 | Tia Marie Heard | Home Health | 4591 Quincy Avenue Building Q, Cleveland, OH 44104 | 2017-07-13 |
| 1407306608 | Shelby Mcquiller | Social Worker | 2632 E 115th St, Cleveland, OH 44104 | 2016-10-11 |
| 1568852390 | Cleveland Arts & Social Sciences Academy | Psychologist | 10701 Shaker Blvd, Cleveland, OH 44104 | 2015-02-02 |
| 1164827705 | Eboni Danyale Jordan | Licensed Practical Nurse | 3143 East 99th, Cleveland, OH 44104 | 2014-10-24 |
| 1902224157 | Woodland Academy, Inc. | Local Education Agency (LEA) | 10615 Lamontier Blvd., Cleveland, OH 44104 | 2014-04-04 |
| 1467793778 | Teresa M Evans-guyton | Nurse Practitioner | 11201 Shaker Blvd Ste 240, Cleveland, OH 44104 | 2013-03-12 |
| 1023387057 | Roslyn Jeanette Carter | Home Health Aide | 9423 Ramona Blvd, Cleveland, OH 44104 | 2011-12-20 |
| Find all providers in zip 44104 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982203246 | Kimberly Fuller, Lisw, LLC | Counselor | 2291 W 38th St, Cleveland, OH 44113-3867 | 2020-10-19 |
| 1255930467 | Jessica Becka LLC | Counselor | 5206 Tillman Ave, Cleveland, OH 44102-2248 | 2020-10-19 |
| 1629675541 | Shayna Mell | Counselor | 4542 Wilburn Dr, Cleveland, OH 44121-3863 | 2020-10-04 |
| 1316552649 | Monisa Ramseur | Counselor | 2800 Euclid Ave Ste 335, Cleveland, OH 44115-2496 | 2020-09-14 |
| 1164031076 | Michele R Princeton | Counselor | 3846 E 65th St, Cleveland, OH 44105-3560 | 2020-07-27 |
| 1700407517 | Cornerstone Behavioral Health LLC | Counselor | 814 E 185th Street, Suite 300, Cleveland, OH 44119 | 2020-05-04 |
| 1811522337 | Mary Cassidy | Counselor | 4128 Lorain Ave, Cleveland, OH 44113-3719 | 2020-03-04 |
| 1285272963 | Theophilus Nikia Williams | Counselor | 3521 W 54th St, Cleveland, OH 44102-5709 | 2019-12-13 |
| 1467098822 | Jordan Community Residential | Counselor | 2231 N Taylor Rd, Cleveland, OH 44112-3044 | 2019-11-20 |
| 1285275529 | Anchor Warrior Center | Counselor | 3505 Adkisson Dr Nw Ste 156, Cleveland, TN 37312-6823 | 2019-10-07 |
| Find all providers in CLEVELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.