PROUD TO BE, INC
NPI 1629840707
Clinic/Center - Mental Health (Including Community Mental Health Center) in Cleveland, OH

Q: What is Proud To Be, Inc's NPI number?

The NPI number for Proud To Be, Inc is 1629840707. It was assigned to this organization in the NPPES registry on October 23, 2023.

Q: What is Proud To Be, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Q: When was this NPI record last updated?

The NPPES record for Proud To Be, Inc was last updated on October 23, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since October 23, 2023

11811 SHAKER BLVD STE 123, CLEVELAND, OH 44120(216) 242-2990 Get Directions Write a Review

NPPES record last updated: October 23, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Proud To Be, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROUD TO BE, INC (NPI 1629840707) is a healthcare organization registered as a mental health (including community mental health center) in Cleveland, Ohio and active in the NPI registry since October 2023. The organization lists Lisa Sullivan, Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1629840707

Entity TypeOrganization

Primary Taxonomy261QM0801X

Legal Business NamePROUD TO BE, INC

Location Address11811 SHAKER BLVD STE 123Cleveland, OH 44120-1927

Mailing Address11811 Shaker Blvd Ste 123Cleveland, OH 44120-1927

Phone(216) 242-2990

Organization SubpartNo

Authorized OfficialLisa SullivanCredentialing Specialist · (440) 453-0754

Enumeration DateOctober 23, 2023

NPPES CertifiedOctober 23, 2023

✔ NPI 1629840707 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities

Taxonomy Code261QM0801X

11811 SHAKER BLVD STE 123, Cleveland, OH 44120

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 36D2151785

Proud To Be, Inc · Cleveland, OH

Expired · Jul 26, 2026

CLIA Number36D2151785

Laboratory TypePsychiatric & Addiction

Certificate Effective DateJuly 27, 2024

Certificate Expiration DateJuly 26, 2026

Laboratory DirectorTiffany M. Martin-Thornton

Laboratory Phone(216) 242-2990

Laboratory LocationProud To Be, Inc11811 Shaker Blvd Suite #123, Cleveland, OH 44120

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

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Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARK MARTIN CDCA.166404

Counselor (Addiction (Substance Use Disorder))