Healthcare Provider Details

I. General information

NPI: 1811204977
Provider Name (Legal Business Name): MINORITY BEHAVIORAL HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 COPLEY RD
AKRON OH
44320-2766
US

IV. Provider business mailing address

1293 COPLEY RD
AKRON OH
44320-2766
US

V. Phone/Fax

Practice location:
  • Phone: 330-374-1199
  • Fax: 330-374-0151
Mailing address:
  • Phone: 330-374-1199
  • Fax: 330-374-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. DEBRA PHILMORE-STROUD
Title or Position: ADMINISTRATOR
Credential: LSW
Phone: 330-374-1199