Healthcare Provider Details

I. General information

NPI: 1558540732
Provider Name (Legal Business Name): CENTRAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 ALBERT SABIN WAY
CINCINNATI OH
45229-2801
US

IV. Provider business mailing address

311 ALBERT SABIN WAY
CINCINNATI OH
45229-2801
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-9006
  • Fax: 513-558-3880
Mailing address:
  • Phone: 513-558-9006
  • Fax: 513-558-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. WALTER S SMITSON
Title or Position: PRESIDENT/CEO
Credential: PHD
Phone: 513-558-9006