Healthcare Provider Details

I. General information

NPI: 1033417910
Provider Name (Legal Business Name): COMPREHENSIVE MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W 5TH ST
EAST LIVERPOOL OH
43920-2849
US

IV. Provider business mailing address

321 W 5TH ST
EAST LIVERPOOL OH
43920-2849
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-8800
  • Fax:
Mailing address:
  • Phone: 330-385-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number35042814
License Number StateOH

VIII. Authorized Official

Name: SASI KAZA
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-797-4050