Healthcare Provider Details

I. General information

NPI: 1770754624
Provider Name (Legal Business Name): A SOUND MIND COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E GALBRAITH RD
CINCINNATI OH
45216-1353
US

IV. Provider business mailing address

203 E GALBRAITH RD
CINCINNATI OH
45216-1353
US

V. Phone/Fax

Practice location:
  • Phone: 513-948-0023
  • Fax: 513-948-0023
Mailing address:
  • Phone: 513-948-0023
  • Fax: 513-948-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0002888
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0020737
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0028602
License Number StateOH

VIII. Authorized Official

Name: DR. SHANTEL THOMAS
Title or Position: CEO
Credential: PH.D.
Phone: 513-948-0023