Provider Demographics
NPI:1366906307
Name:LITTLEJOHN, GREGORY R II (QMHS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:LITTLEJOHN
Suffix:II
Gender:M
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5912
Mailing Address - Country:US
Mailing Address - Phone:216-777-9035
Mailing Address - Fax:
Practice Address - Street 1:13301 BEACHWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6415
Practice Address - Country:US
Practice Address - Phone:216-777-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator