MEDICARE: TRAILHEAD PSYCHOLOGY, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1376494625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAILHEAD PSYCHOLOGY, LLC

Provider Business Mailing Address
First Line	:	28 TANGLEWOOD DR
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-1238
Country	:	US
Telephone Number	:	937-869-4325
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 TANGLEWOOD DR
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-1238
Country	:	US
Telephone Number	:	937-869-4325
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	LEANNA PITTSENBARGER
Credential	:	PSY.D.
Telephone Number	:	937-869-4325

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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