Healthcare Provider Details

I. General information

NPI: 1417157744
Provider Name (Legal Business Name): DARKE COUNTY MENTAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E MAIN ST
GREENVILLE OH
45331-1913
US

IV. Provider business mailing address

212 E MAIN ST
GREENVILLE OH
45331-1913
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-1635
  • Fax: 937-548-1500
Mailing address:
  • Phone: 937-548-1635
  • Fax: 937-548-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberS0008198
License Number StateOH

VIII. Authorized Official

Name: DR. JMAES MOORE
Title or Position: EXECUTIVE DIRECTOR
Credential: PSYD
Phone: 937-548-1635