Healthcare Provider Details

I. General information

NPI: 1033547617
Provider Name (Legal Business Name): MIAMI VALLEY INTEGRATED PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 OAK CT STE 211
BEAVERCREEK OH
45430-1064
US

IV. Provider business mailing address

1430 OAK CT STE 211
BEAVERCREEK OH
45430-1064
US

V. Phone/Fax

Practice location:
  • Phone: 937-304-1615
  • Fax: 937-439-2984
Mailing address:
  • Phone: 937-304-1615
  • Fax: 937-439-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA K MATTHIAS
Title or Position: OWNER/PROVIDER
Credential: LISW-S
Phone: 937-304-1615