MEDICARE: ALLIANCE THERAPEUTIC PRACTICES, LLC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1295340511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE THERAPEUTIC PRACTICES, LLC

Provider Business Mailing Address
First Line	:	822 DELTA AVE STE 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45226-1256
Country	:	US
Telephone Number	:	513-460-9533
Fax Number	:

Provider Business Practice Location Address
First Line	:	822 DELTA AVE STE 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45226-1256
Country	:	US
Telephone Number	:	513-460-9533
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	TINA M CADAVID
Credential	:	LISW-S
Telephone Number	:	513-460-9533

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	09/14/2020

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