Healthcare Provider Details

I. General information

NPI: 1629821319
Provider Name (Legal Business Name): OCD ANXIETY CENTERS OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11427 REED HARTMAN HWY
BLUE ASH OH
45241-2418
US

IV. Provider business mailing address

11260 S RIVER HEIGHTS DR
SOUTH JORDAN UT
84095-5119
US

V. Phone/Fax

Practice location:
  • Phone: 888-695-7682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAUL PETERSON
Title or Position: CEO
Credential:
Phone: 385-333-6555