Healthcare Provider Details

I. General information

NPI: 1295340511
Provider Name (Legal Business Name): ALLIANCE THERAPEUTIC PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 DELTA AVE STE 1
CINCINNATI OH
45226-1256
US

IV. Provider business mailing address

822 DELTA AVE STE 1
CINCINNATI OH
45226-1256
US

V. Phone/Fax

Practice location:
  • Phone: 513-460-9533
  • Fax:
Mailing address:
  • Phone: 513-460-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TINA M CADAVID
Title or Position: THERAPIST
Credential: LISW-S
Phone: 513-460-9533