Healthcare Provider Details

I. General information

NPI: 1154234409
Provider Name (Legal Business Name): SHAWNEE MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CARLTON DAVIDSON LN
COAL GROVE OH
45638-2924
US

IV. Provider business mailing address

225 CARLTON DAVIDSON LN
COAL GROVE OH
45638-2924
US

V. Phone/Fax

Practice location:
  • Phone: 740-533-0648
  • Fax: 740-533-6284
Mailing address:
  • Phone: 740-533-0648
  • Fax: 740-533-6284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: CYNTHIA HOLSTEIN
Title or Position: CEO
Credential:
Phone: 740-355-8686