Healthcare Provider Details

I. General information

NPI: 1265730451
Provider Name (Legal Business Name): JOSEPH L CIMOCH LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S EDWIN C MOSES BLVD
DAYTON OH
45417
US

IV. Provider business mailing address

921 S EDWIN C MOSES BLVD
DAYTON OH
45417
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-1376
  • Fax: 937-461-9280
Mailing address:
  • Phone: 937-461-1376
  • Fax: 937-461-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1874
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: