JEFFREY JACK


Address: 2801 Martin Luther King Jr Dr, Cleveland, OH 44104
Phone: 2164486325

JEFFREY JACK (NPI# 1346754124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

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

Taxonomy

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

Provider Secondary Practice Location

Address Telephone Number Fax Number
2801 Martin Luther King Jr Dr, Cleveland, OH 44104 2164486325
3929 Rocky River Dr, Cleveland, OH 441114153 2162525800

Office Location

Street Address 2801 MARTIN LUTHER KING JR DR
City CLEVELAND
State OH
Zip Code 44104

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 101YM0800X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Mental Health

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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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
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Competitor

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City CLEVELAND
Zip Code 44104

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Dataset Information

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.

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