Healthcare Provider Details

I. General information

NPI: 1154144335
Provider Name (Legal Business Name): MENTAL HEALTH HEALING PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6838 LOOP RD
CENTERVILLE OH
45459-2159
US

IV. Provider business mailing address

6838 LOOP RD
CENTERVILLE OH
45459-2159
US

V. Phone/Fax

Practice location:
  • Phone: 937-270-3411
  • Fax:
Mailing address:
  • Phone: 937-270-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA SUE BAKER
Title or Position: OWNER/OFFICE MANAGER
Credential: LISW-S
Phone: 937-270-3411