Healthcare Provider Details

I. General information

NPI: 1528556784
Provider Name (Legal Business Name): TRUMPET BEHAVIORAL HELTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 COMMERCE CENTER BLVD
FAIRBORN OH
45324-6333
US

IV. Provider business mailing address

310 CLOVER LN APT K
BEAVERCREEK OH
45440-4540
US

V. Phone/Fax

Practice location:
  • Phone: 937-878-8444
  • Fax:
Mailing address:
  • Phone: 502-600-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA KAPEL
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 937-303-2213