Active NPI
Tymira Angelique Stenson, CDCA
- Community/Behavioral Health Agency
- Cleveland, OH
National Provider Identifier
1124547302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- CDCD.163983
- Practice address
- 30800 Chagrin Blvd
Cleveland, OH 44124-5925 - Phone
- (216) 591-0324
- NPI assigned
- Sep 19, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | CDCD.163983 | OH | Primary |
Addresses
Primary practice location
30800 Chagrin Blvd
Cleveland, OH 44124-5925
Mailing address
30800 Chagrin Blvd
Cleveland, OH 44124-5925
Phone (216) 591-0324
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2374229 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CDCD.163983 | OH | MD | Community/Behavioral Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1124547302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30800 CHAGRIN BLVD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441245925",
"telephone_number": "216-591-0324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30800 CHAGRIN BLVD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441245925",
"telephone_number": "216-591-0324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STENSON",
"first_name": "TYMIRA",
"middle_name": "ANGELIQUE",
"credential": "CDCA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-19",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "OH",
"license": "CDCD.163983",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2374229",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.