MEDICARE: PANACEA BEHAVIOR THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1235742685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANACEA BEHAVIOR THERAPY

Provider Business Mailing Address
First Line	:	2703 MAHONING AVE STE 103
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-2337
Country	:	US
Telephone Number	:	330-980-2353
Fax Number	:	330-781-5178

Provider Business Practice Location Address
First Line	:	2703 MAHONING AVE STE 103
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-2337
Country	:	US
Telephone Number	:	330-980-2353
Fax Number	:	330-781-5178

Authorized Official
Title or Position	:	OWNER
Name	:	FAITH PALMER
Credential	:	CDCA
Telephone Number	:	330-980-2353

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	08/26/2020

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Directions to “PANACEA BEHAVIOR THERAPY ” Practice Location

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